Prognostic value of LV deformation parameters using 2D and 3D speckle-tracking echocardiography in asymptomatic patients with severe aortic stenosis and preserved LV ejection fraction

JACC Cardiovasc Imaging. 2015 Mar;8(3):235-245. doi: 10.1016/j.jcmg.2014.12.009. Epub 2015 Feb 11.

Abstract

Objectives: The objective of this study was to determine which strain component assessed by 2-dimensional speckle-tracking echocardiography (2DSTE) and 3-dimensional speckle-tracking echocardiography (3DSTE) was the most powerful predictor for future major adverse cardiac events (MACE) in asymptomatic patients with severe aortic stenosis (AS).

Background: Ongoing debate exists regarding the appropriateness of early surgery in asymptomatic severe AS and preserved left ventricular ejection fraction (LVEF). Previous studies showed that 2-dimensional global longitudinal strain (2DGLS) was a significant predictor in asymptomatic severe AS patients. However, the prognostic utility of 3DSTE-derived multidirectional strain parameters has not been investigated in these patients.

Methods: We enrolled 104 asymptomatic severe AS patients (indexed aortic valve area <0.6 cm(2)/m(2)) and preserved LVEF and performed strain analysis using both 2DSTE and 3DSTE. Two-dimensional and 3-dimensional global longitudinal, circumferential, and radial strain and global 3-dimensional strain were measured in each patient. All patients were followed to record MACE.

Results: During a median follow-up of 373 days, MACE developed in 33 patients (32%). 2DGLS (-14.7 ± 3.3 vs. -16.3 ± 3.3, p = 0.0168), 3DGLS (-13.5 ± 2.5 vs. -16.1 ± 2.4, p < 0.0001) and 3-dimensional global radial strain (3DGRS) (35.9 ± 4.5 vs. 38.1 ± 4.4, p = 0.0209) were significantly impaired in patients with MACE compared with those without MACE. Kaplan-Meier analysis showed 2DGLS (cutoff: -17.0%), 3DGLS (cutoff: -14.5%), and 3DGRS (cutoff: 39.0%) provide a significant difference in MACE rate. Receiver-operating characteristic analysis revealed that the area under the curve of 3DGLS for MACE (0.78) was significantly larger than that of 2DGLS (0.62, p = 0.0044) and 3DGRS (0.66, p = 0.0069). Separate multivariate analysis revealed 3DGLS was only significant as independent predictor for future MACE after correcting for mean pressure gradient and left ventricular mass index.

Conclusions: 3DGLS is the most robust index for predicting future adverse cardiac events in asymptomatic severe AS patients with preserved LVEF.

Keywords: 3D echocardiography; aortic stenosis; prognosis; strain.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging*
  • Aortic Valve / physiopathology
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / diagnostic imaging*
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / physiopathology
  • Area Under Curve
  • Asymptomatic Diseases
  • Biomechanical Phenomena
  • Disease Progression
  • Echocardiography, Doppler*
  • Echocardiography, Three-Dimensional*
  • Female
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / physiopathology
  • Humans
  • Japan
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Myocardial Contraction
  • Observer Variation
  • Predictive Value of Tests
  • Prognosis
  • ROC Curve
  • Reproducibility of Results
  • Severity of Illness Index
  • Stress, Mechanical
  • Stroke Volume*
  • Time Factors
  • Ventricular Function, Left*
  • Ventricular Pressure