Natural history of severe aortic stenosis: Diastolic wall strain as a novel prognostic marker.
Echocardiography
; 34(4): 484-490, 2017 Apr.
Article
en En
| MEDLINE
| ID: mdl-28247566
ABSTRACT
BACKGROUND AND AIM:
Diastolic wall strain (DWS) has been proposed as a simple noninvasive measure of left ventricular (LV) stiffness. This study investigated DWS as a possible predictor of mortality in severe aortic stenosis (AS).METHODS:
138 patients with severe AS (indexed aortic valve area [AVA]<0.6 cm2 /m2 ) and normal ejection fraction (>55%) were included. 52 patients (38%) had aortic valve interventions or poor image quality (n=5) and were excluded leaving 86 in the study group (84±8 years, 70% female, 69% African American). DWS was defined as (LVPWs-LVPWd)/LVPWs where LVPWs=left ventricular posterior wall thickness in systole and LVPWd=left ventricular wall thickness in diastole.RESULTS:
Follow-up extended 2.0±1.9 years (median 1.6 years). Mean DWS for the group was 0.21±0.11 (normal=0.4±0.07). In patients who died, DWS was significantly lower than in survivors (0.18±0.09 vs 0.24±0.11, P=.02). By contrast, traditional measures of diastolic dysfunction did not predict death. Regression analysis showed DWS predicted death even after adjusting for age, sex, race, indexed AVA, symptoms (angina, shortness of breath, dizziness, syncope), and clinical factors (creatinine, smoking, diabetes, hypertension, hyperlipidemia) (HR 2.5 [95% CI 1.02-5.90], P<.05). The best cutoff value for DWS of 0.25 had a sensitivity of 42% and specificity of 83% for predicting death.CONCLUSIONS:
DWS is an independent predictor of all-cause mortality in patients with severe AS, even after accounting for traditional clinical and echocardiographic parameters.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Estenosis de la Válvula Aórtica
/
Ecocardiografía
Tipo de estudio:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged80
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Female
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Humans
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Male
Idioma:
En
Revista:
Echocardiography
Asunto de la revista:
CARDIOLOGIA
/
DIAGNOSTICO POR IMAGEM
Año:
2017
Tipo del documento:
Article
País de afiliación:
Estados Unidos