Left ventricular global longitudinal strain predicts death risk in aortic stenosis

In patients with moderate aortic stenosis (AS) and reduced left ventricular (LV) systolic dysfunction, LV global longitudinal strain (GLS) appears to be an independent indicator of mortality, a new study has found.

Adding LV GLS to established predictive risk factors incrementally improves their prognostic value.

Researchers enrolled 166 patients (mean age 73 years, 71 percent men), in whom speckle-tracking echocardiography was used to measure LV GLS. Spline curve analysis revealed an optimal GLS threshold of 11 percent, which was then used to categorize the patients into two groups. The primary outcome was all-cause mortality.

Over a median follow-up of 34 months, 73 patients died, yielding a mortality rate of 44 percent. The cumulative 1-, 3-, and 5-year survival estimates were 82 percent, 68 percent, and 55 percent, respectively. Significant differences were reported according to LV GLS.

For instance, patients with GLS measurements below 11 percent had significantly higher 1-year mortality rates (25 percent vs 10 percent), an effect that remained true at the 5-year mark (60 percent vs 27 percent; p<0.001).

Multivariable analysis confirmed that LV GLS <11 percent was a significant risk factor for death, aggravating such likelihood by more than threefold (hazard ratio [HR], 3.028, 95 percent confidence interval [CI], 1.623–5.648; p<0.001). This remained true when taking LV GLS as a continuous variable (HR, 0.753, 95 percent CI, 0.673–0.843; p<0.001).