title: Prognostic value of global left ventricular strain for conservatively treated patients with symptomatic aortic stenosis.
abstract: OBJECTIVE
  Impaired left ventricular (LV) strain is associated with an increased risk of cardiac events in asymptomatic severe aortic stenosis (AS). We aimed to evaluate the prognostic value of global LV strain in conservatively treated patients with symptomatic AS.
  
  
  RESULTS
  This cohort study retrospectively reviewed symptomatic AS patients who were treated conservatively or surgically between July 2007 and April 2010. We measured their global longitudinal strain (GLS) and global circumferential strain (GCS). Clinical events were defined as readmission for heart failure or all-cause death for 2 years. GLS and GCS could predict a worse outcome in the conservatively treated group at cut-offs of =-16.5% (77% sensitivity and 67% specificity) and =-22.2% (92% sensitivity and 83% specificity), respectively. By univariate Cox regression analysis, age, logistic EuroSCORE, aortic valve area, GLS, and GCS were significant predictors. When adjusted for age, logistic EuroSCORE, and aortic valve area, impaired GLS and GCS were independently associated with a higher risk of clinical events.
  
  
  CONCLUSIONS
  In conservatively treated patients with symptomatic AS, impaired GLS and GCS were associated with an increased risk of cardiac events during a 2-year follow-up. Global LV strain may help to define a higher risk subset; therefore, a larger and prospective observation study would be necessary.
authors.affiliation: First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Taoyuan, Taiwan.
authors.forename: Hsin-Fu
authors.initials: HF
authors.lastname: Lee
authors.forename: Lung-An
authors.initials: LA
authors.lastname: Hsu
authors.forename: Yi-Hsin
authors.initials: YH
authors.lastname: Chan
authors.forename: Chun-Li
authors.initials: CL
authors.lastname: Wang
authors.forename: Chi-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Chi-Tai
authors.initials: CT
authors.lastname: Kuo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: Aortic stenosis; Echocardiography; Outcome; Speckle tracking; Strain