Author + information
- Received July 12, 2018
- Revision received November 9, 2018
- Accepted November 13, 2018
- Published online January 7, 2019.
- Julien Magne, PhDa,∗ (, )
- Bernard Cosyns, MD, PhDb,
- Bogdan A. Popescu, MD, PhDc,
- Helle G. Carstensen, MD, PhDd,
- Jordi Dahl, MD, PhDe,
- Milind Y. Desai, MDf,
- Leighton Kearney, MD, PhDg,
- Patrizio Lancellotti, MD, PhDh,i,
- Thomas H. Marwick, MD, PhD, MPHj,
- Kimi Sato, MD, PhDk,
- Masaaki Takeuchi, MD, PhDl,
- Concetta Zito, MD, PhDm,
- Anne-Claire Casalta, MDd,
- Dania Mohty, MD, PhDa,
- Luc Piérard, MD, PhDh,
- Gilbert Habib, MD, PhDn and
- Erwan Donal, MD, PhDo
- aCHU Limoges, Hôpital Dupuytren, Service Cardiologie, INSERM 1094, Limoges, France
- bUZ Brussel-CVHZ, Brussels, Belgium
- cUniversity of Medicine and Pharmacy “Carol Davila”—Euroecolab, Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,”, Bucharest, Romania
- dDepartment of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- eDepartment of Cardiology, Odense University Hospital, Odense, Denmark
- fHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- gDepartment of Cardiology, Austin Health, Heidelberg, Victoria, Australia
- hUniversity of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU Sart Tilman, Liège, Belgium
- iGruppo Villa Maria Care and Research, Anthea, Bari, Italy
- jBaker Heart and Diabetes Institute, Melbourne, Australia
- kDepartment of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- lDepartment of Laboratory and Transfusion Medicine, Hopital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
- mCardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- nAix-Marseille Université, APHM, La Timone Hospital, Cardiology Department, Marseille, France
- oCardiologie et CIC-IT 1414, CHU Rennes; LTSI, Inserm 1099, University Rennes 1, Rennes, France
- ↵∗Address for correspondence:
Dr. Julien Magne, CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges F-87042, France.
Objectives In this individual participant data meta-analysis on left ventricular global longitudinal strain (LVGLS), our objective was to: 1) describe its distribution; 2) identify the most predictive cutoff values; and 3) assess its impact on mortality in asymptomatic patients with significant aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF).
Background The evidence supporting the prognostic role of LVGLS in asymptomatic patients with AS has been obtained from several relatively small studies.
Methods A literature search was performed for studies published between 2005 and 2017 without language restriction according to the following criteria: “aortic stenosis” AND “longitudinal strain.” The corresponding authors of selected studies were contacted and invited to share their data that we computerized in a specific database. The primary endpoint was all-cause mortality.
Results Among the 10 studies included, 1,067 asymptomatic patients with significant AS and LVEF >50% were analyzed. The median of LVGLS was 16.2% (from 5.6% to 30.1%). There were 91 deaths reported during follow-up with median of 1.8 (0.9 to 2.8) years, resulting in a pooled crude mortality rate of 8.5%. The LVGLS performed well in the prediction of death (area under the curve: 0.68). The best cutoff value identified was LVGLS of 14.7% (sensitivity, 60%; specificity, 70%). Using random effects model, the risk of death for patients with LVGLS <14.7% is multiplied by >2.5 (hazard ratio: 2.62; 95% confidence interval: 1.66 to 4.13; p < 0.0001), without significant heterogeneity between studies (I2 = 18.3%; p = 0.275). The relationship between LVGLS and mortality remained significant in patients with LVEF ≥60% (p = 0.001).
Conclusions This individual participant data meta-analysis demonstrates that in asymptomatic patients with significant AS and normal LVEF, impaired LVGLS is associated with reduced survival. These data emphasize the potential usefulness of LVGLS for risk stratification and management of these patients.
Dr. Popescu has received research support and lecture honoraria from GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Jagat Narula, MD, served as Guest Editor for this paper.
- Received July 12, 2018.
- Revision received November 9, 2018.
- Accepted November 13, 2018.
- 2018 American College of Cardiology Foundation
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