Author + information
- Akhil Narang,
- Noreen Nazir,
- Kirk Spencer,
- Victor Mor-Avi,
- Roberto Lang and
- Karima Addetia
Background: In chronic, severe aortic insufficiency (sAI), guidelines recommend aortic valve replacement (AVR) when left ventricular (LV) ejection fraction (EF) is <50% or LV dilation occurs at end-diastole or end-systole (LVEDD, LVESD). In patients with normal LV EF sAI is associated with volume/pressure overload which may have an impact on LV function. LV global longitudinal strain (GLS) can detect subclinical LV dysfunction. We hypothesized that reduced GLS might predict mortality in patients with sAI and could be used to stratify patients who were otherwise not candidates for AVR.
Methods: 24 consecutive patients (54±18y; 71% male) with sAI (vena contracta >0.6cm) on echocardiogram were identified while excluding those with severe aortic stenosis, prosthetic AV, or vegetation. Associations between LVEF, LVEDD, LVESD, and GLS with all-cause mortality were determined by review of the medical charts and social security death index.
Results: During mean follow-up of 3 years, 16 patients lived and 8 died. The LVEF, LVEDD, LVESD in the alive and dead cohorts were: 59±7% and 56±6% (P=0.27), 5.5±0.8cm and 5.9±0.8cm (P=0.26), 3.5±0.6cm and 4.2±0.6cm (P=0.01). GLS was significantly different between the 2 cohorts (-20±2% vs -15±1%, P<0.001) (Fig A). Survival analysis using a GLS cut-off of -17.4% predicted mortality (Fig B).
Conclusions: GLS provides added value in risk stratifying patients with sAI and normal LVEF. Future studies validating the above cut-off are warranted and could impact future guidelines.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Valvular Heart Disease: Aortic Regurgitation
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1184-028
- 2017 American College of Cardiology Foundation