Abstract 15033: Left Ventricular Global Longitudinal Strain Provides Incremental Prognostic Utility in Asymptomatic Patients With Significant Chronic Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction
Background: Chronic severe aortic regurgitation (AR) results in long-term left ventricular (LV) volume and pressure overload, with a long asymptomatic stage. In un-operated patients, survival is reduced once symptoms develop or LV ejection fraction (LVEF) drops. We sought to assess the incremental utility of LV-global longitudinal strain (LV-GLS) in asymptomatic patients with ≥3+ chronic aortic regurgitation & preserved LVEF (≥50%).
Methods: We studied 1143 such patients (mean age 54±16 years, 78% men) seen at our tertiary center between 2003-10 (excluding ≥moderate aortic stenosis, prior aortic valve (AV) surgery, ≥moderate mitral disease). Clinical, echocardiographic (including 2, 3 & 4-chamber LV-GLS using Velocity Vector Imaging) & surgical data was obtained. Society of Thoracic Score (STS) was calculated. Primary endpoint was mortality.
Results: Mean STS score and LVEF were 4.4±5% and 57±4%, while 133 (12%) patients had LV end-diastolic dimension ≥6.5 cm and 80 (7%) had indexed LV end-systolic dimension (iLVESD) ≥2.5 cm/m2. Median LV-GLS was -19.5% [-18.0% to -21.1%]. 13% patient were symptomatic. At 6.9±3 years of follow-up, 741 (65%) patients underwent AV surgery (23% isolated AV surgery, 9% concomitant coronary bypass & 38% aortic replacement) & 153 (13%) died. 30-day post-operative mortality occurred in 8 (0.7%). On multivariate Cox survival analysis, worse LV-GLS (Hazard ratio or HR 2.56 [1.27-5.16]) & AV surgery (HR 0.34 [0.24-0.48]) were associated with mortality (both p<0.001), after adjustment of known factors. Kaplan-Meier survival curves (LV-GLS better or worse than median) are shown in Figure. Sequential addition of LV-GLS & AV surgery to STS score increased c-statistic for longer-term mortality from 0.61 (CI 0.52-0.78) to 0.70 (0.61-0.85) to 0.78 (0.69-0.91), p<0.001.
Conclusions: In asymptomatic patients with ≥3+ chronic AR & preserved LVEF, worse LV-GLS was associated with long-term mortality, while AV surgery improved survival
Author Disclosures: A. Alashi: None. A. Mentias: None. K. Feng: None. A. Abdallah: None. A. Gillinov: None. L. Rodriguez: None. J.F. Sabik: None. L.G. Svensson: None. Z.B. Popovic: None. B.P. Griffin: None. M.Y. Desai: None.
- © 2016 by American Heart Association, Inc.