Author + information
- Chetan Huded,
- Andrew Goodman,
- Kenya Kusunose,
- Lars Svensson,
- A. Gillinov,
- Brian Griffin and
- Milind Desai
Background: Valvuloarterial impedance (ZVa) & left ventricular global longitudinal strain (LV-GLS) are individually associated with survival in patients with aortic stenosis (AS), but their synergistic association vis-à-vis prognosis is unknown.
Methods: We studied 462 patients (mean age 71 years, 63% men) with significant AS (valve area <1.3cm2) 1/1/08 to 6/30/08, excluding patients with other severe valvular disease & LV ejection fraction (LVEF) <50%. ZVa was measured as: (systolic arterial pressure + mean pressure gradient)/LV-stroke volume index. LV-GLS was measured offline using Velocity Vector Imaging (Siemens). We stratified ZVa into low impedance (LI) & high impedance (HI) based on a median of 4.4 mm Hg*ml-1*m2, & LV-GLS into low strain (LS) & high strain (HS) based on a median of -14.1%. The primary endpoint was death.
Results: 140 (30%) had LI-HS, 93 (20%) had LI-LS, 93 (20%) had HI-HS & 136 (29%) had HI-LS. 282 (61%) patients underwent aortic valve replacement (AVR) & long-term deaths occurred in 120 (26%); 30-day postoperative deaths occurred in 0.02%. In AVR patients, LI-HS group had the best long-term survival while patients with either HI, LS, or both had worse survival (Figure a). In patients without AVR, HI-LS group had the highest risk of death vs. LI-HS group, while those with LI or HS demonstrated an intermediate prognosis (Figure b).
Conclusions: In patients with severe AS, a combination of abnormal Zva & LV-GLS provide synergistic & incremental prognostic utility, with or without AVR.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:00 a.m.-11:10 a.m.
Session Title: Novel Determinants of Outcomes in VHD
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1132M-11
- 2017 American College of Cardiology Foundation