title: Usefulness of global left ventricular longitudinal strain for risk stratification in low ejection fraction, low-gradient aortic stenosis: results from the multicenter True or Pseudo-Severe Aortic Stenosis study.
abstract: BACKGROUND
  The objective of this study was to examine the impact of left ventricular (LV) global longitudinal strain (GLS) measured at rest and at dobutamine stress echocardiography on the outcome of patients with low LV ejection fraction and low-gradient aortic stenosis.
  
  
  RESULTS
  Among the 202 patients with low LV ejection fraction (≤40%), low-gradient aortic stenosis (mean transvalvular gradient <40 mm Hg and indexed aortic valve area ≤0.6 cm(2)/m(2)) prospectively enrolled in the multicenter True or Pseudo-Severe Aortic Stenosis study, 126 patients with resting GLS and 73 patients with stress GLS available were included in this substudy. Three-year survival rate was 49% in patients with rest GLS <|9|% compared with 68% in patients with GLS >|9|% (P=0.02). In a multivariable Cox model adjusted for age, coronary artery disease, projected aortic valve area at a normal flow rate and type of treatment (aortic valve replacement versus conservative), rest GLS <|9|% (hazard ratio, 2.18; P=0.015) remained independently associated with all-cause mortality. GLS <|10|% measured during dobutamine stress echocardiography was also independently associated with mortality (hazard ratio, 2.67; P=0.01). In the subset of patients with stress GLS (n=73), the χ(2) of the multivariable model to predict all-causes mortality was 21.96 for stress GLS versus 17.78 for rest GLS.
  
  
  CONCLUSIONS
  GLS is independently associated with mortality in patients with low LV ejection fraction, low-gradient aortic stenosis. Stress GLS measured during dobutamine stress echocardiography may provide incremental prognostic value beyond GLS measured at rest. Hence, measurement of GLS at rest and during dobutamine stress echocardiography may be helpful to enhance risk stratification in low LV ejection fraction, low-gradient aortic stenosis.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01835028.
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Abdellaziz
authors: A
authors: Dahou
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Philipp Emanuel
authors: PE
authors: Bartko
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Romain
authors: R
authors: Capoulade
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Marie-Annick
authors: MA
authors: Clavel
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Gerald
authors: G
authors: Mundigler
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Samuel Larue
authors: SL
authors: Grondin
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Jutta
authors: J
authors: Bergler-Klein
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Ian
authors: I
authors: Burwash
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Jean G
authors: JG
authors: Dumesnil
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Mario
authors: M
authors: Sénéchal
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Kim
authors: K
authors: O'Connor
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.).
authors: Helmut
authors: H
authors: Baumgartner
authors: From the Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada (A.D., R.C., M.-A.C., S.L.G., J.G.D., M.S., K.O'C., P.P.); Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, (P.E.B., G.M., J.B.-K.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.B.); and Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B.). philippe.pibarot@med.ulaval.ca.
authors: Philippe
authors: P
authors: Pibarot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D018619:Echocardiography, Doppler, Pulsed; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: aortic valve stenosis; echocardiography, stress; longitudinal strain; low flow; low gradient; outcome measures