title: Relationship between longitudinal strain and symptomatic status in aortic stenosis.
abstract: BACKGROUND
  Global longitudinal strain (GLS) and basal longitudinal strain (BLS) assessed using two-dimensional speckle-tracking imaging have been proposed as subtle markers of left ventricular (LV) systolic dysfunction with potential prognostic value in patients with aortic stenosis (AS). The aim of this study was to evaluate the relationship between longitudinal strain and symptomatic status in patients with AS.
  
  
  METHODS
  GLS and BLS were measured in 171 patients with pure, isolated, at least mild AS prospectively enrolled at two institutions. The population was divided into four groups: asymptomatic nonsevere AS (n = 55), asymptomatic severe AS with preserved LV ejection fraction (LVEF; ≥50%) (n = 37), symptomatic severe AS with preserved LVEF (n = 60), and severe AS with reduced LVEF (<50%) (n = 19).
  
  
  RESULTS
  GLS was significantly different among the four groups (P < .0001), but the difference was due mainly to patients with reduced LVEFs. In addition, there was an important overlap among the groups, and in multivariate analysis, after adjustment for age, gender, AS severity, and LVEF, GLS was not an independent predictor of symptomatic status (P = .07). BLS was also significantly different among the four groups (P < .0001) but in contrast was independently associated with symptomatic status (P < .0001). However, as for GLS, there was an important overlap between groups and differences were close to intraobserver or interobserver variability (1.3 ± 1.1% and 2.0 ± 1.6%, respectively).
  
  
  CONCLUSIONS
  In this prospective multicenter cohort of patients with wide ranges of AS severity, symptoms, and LVEFs, BLS but not GLS was independently associated with symptomatic status. However, there was an important overlap among groups, and differences were close to measurements' reproducibility, raising caution regarding the use of longitudinal strain, at least as a single criterion, in the decision-making process for patients with severe asymptomatic AS.
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Attias
authors.forename: Laurent
authors.initials: L
authors.lastname: Macron
authors.forename: Julien
authors.initials: J
authors.lastname: Dreyfus
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Monin
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: Laurent
authors.initials: L
authors.lastname: Lepage
authors.forename: Guillaume
authors.initials: G
authors.lastname: Hekimian
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: ALS; AS; AUC; AVA; Aortic Stenosis in Elderly: Determinant of Progression; Aortic stenosis; Aortic valve area; Apical longitudinal strain; Area under the receiver operating characteristic curve; BLS; Basal longitudinal strain; CAD; COFRASA; Coronary artery disease; Echocardiography; GENERAC; GLS; Genetic of Aortic Valve Stenosis: Clinical and Therapeutic Implications; Global longitudinal strain; LV; LVEF; Left ventricular; Left ventricular ejection fraction; Longitudinal strain; MPG; Mean pressure gradient; Speckle-tracking