Author + information
- Received August 31, 2018
- Revision received December 19, 2018
- Accepted December 20, 2018
- Published online February 13, 2019.
- Alaa Alashi, MD,
- Tamanna Khullar, MD,
- Amgad Mentias, MD,
- A. Marc Gillinov, MD,
- Eric E. Roselli, MD,
- Lars G. Svensson, MD, PhD,
- Zoran B. Popovic, MD, PhD,
- Brian P. Griffin, MD and
- Milind Y. Desai, MD∗ (, )@DesaiMilindY
- Valve Center, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Milind Desai, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, Ohio 44195.
Objectives This study sought to determine whether baseline left ventricular global longitudinal strain (LV-GLS) and changes in left ventricular ejection fraction (LVEF) in a subgroup of subjects at post-operative follow-up added prognostic value in patients undergoing aortic valve (AV) surgery.
Background In patients with chronic severe aortic regurgitation (AR) and preserved LVEF, sensitive markers are needed to decide timing of AV surgery.
Methods This was an observational study in 865 patients (asymptomatic/mildly symptomatic, 52 ± 15 years of age, 79% men) with ≥3+ chronic AR and preserved LVEF of ≥50% who underwent AV surgery between 2003 and 2015. All patients had baseline echo (and LV-GLS imaging), whereas 285 patients underwent post-operative echo (including LV-GLS). Primary outcome was mortality.
Results Only 478 patients (56%) patients had preoperative LV-GLS values better than −19%, despite a mean LVEF of 57 ± 4%. At a median 38 days, 632 patients underwent AV replacement, whereas 233 patients had AV repair. At a median follow-up of 6.95 (interquartile range [IQR]: 5.2 to 9.1) years, 105 patients (12%) died (2% in-hospital deaths). A higher proportion of patients with baseline LV-GLS grades worse than −19% died versus those whose LV-GLS score was better (15% vs. 10%; p < 0.01), and worse LV-GLS value was independently associated with higher longer-term mortality (hazard ratio: 1.62; 95% confidence interval [CI]: 1.40 to 1.86]; p < 0.001). In the 285 patients who underwent echo at 3 to 12 months post-operatively, LVEF normalized in 91% patients; however, only 88 patients (31%) had LV-GLS values better than −19%. Patients whose follow-up LV-GLS value was better than −19% had significantly better longer-term survival than those whose LV-GLS was not (5% vs. 15%, respectively; p < 0.01). An absolute worsening of 5% of LV-GLS from baseline was associated with increased mortality.
Conclusions In patients with ≥3+ chronic AR and preserved LVEF undergoing AV surgery, a baseline LV-GLS value worse than −19% was associated with reduced survival. In a subgroup of patients who returned for 3- and 12-month follow-up examinations, persistently impaired LV-GLS was associated with increased mortality.
Drs. Alashi and Khullar contributed equally to the work and are co-first authors. Dr. Gillinov is a consultant for Abbott, Medtronic, St. Jude’s Medical, Edwards Lifesciences, CryoLife, and Atricure; and holds equity in ClearFlow. Dr. Roselli is a consultant for Cryolife, Gore, and Terumo; and receives honoraria from Abbott, Edwards Lifesciences, LivaNova, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 31, 2018.
- Revision received December 19, 2018.
- Accepted December 20, 2018.
- 2019 American College of Cardiology Foundation
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