title: Basal longitudinal strain predicts future aortic valve replacement in asymptomatic patients with aortic stenosis.
abstract: OBJECTIVE
  To evaluate the prognostic value of global longitudinal strain (GLS) and basal longitudinal strain (BLS) with the knowledge of coexisting coronary pathology evaluated by multi-detector computed tomography (MDCT) coronary angiography.
  
  
  BACKGROUND
  GLS and BLS are both sensitive markers of myocardial dysfunction and predictors of outcome in asymptomatic aortic stenosis. Aortic stenosis and ischaemic heart disease share risk factors and longitudinal function can be severely reduced in both conditions, why some of the previous findings of impaired regional longitudinal function in asymptomatic aortic stenosis could in fact be explained by silent ischaemic heart disease.
  
  
  RESULTS
  Prospective follow-up of 104 asymptomatic patients with moderate-severe aortic stenosis defined as an aortic valve area <1.5 cm(2). Patients underwent a thorough clinical work-up, advanced echocardiographic analysis and coronary angiography by MDCT. The combined endpoint was indication for aortic valve replacement (AVR) and sudden cardiac death. During a median follow-up of 2.3 years (interquartile range 1.7-3.6) 43 patients (41%) met the endpoint of indication for AVR. The basal (13.4 ± 3.1% vs. 15.7 ± 3.1%) and mid-ventricular segments (14.9 ± 2.7% vs. 16.2 ± 2.9%) were significantly reduced, but with sparing of the apical segments, in patients who later underwent AVR. In various multivariable Cox regression models, including only BLS, but not GLS, remained an independent predictor of AVR.
  
  
  CONCLUSIONS
  In contrast to GLS, reduced BLS is a significant predictor of future AVR in asymptomatic patients with aortic stenosis, independently of clinical characteristics, conventional echocardiographic measures, and coronary pathology.
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, DK-2900 Copenhagen, Denmark hellegervig@hotmail.com.
authors.forename: Helle Gervig
authors.initials: HG
authors.lastname: Carstensen
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Linnea Hornbech
authors.initials: LH
authors.lastname: Larsen
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Klaus Fuglsang
authors.initials: KF
authors.lastname: Kofoed
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, DK-2900 Copenhagen, Denmark.
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Mogelvang
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D058070:Asymptomatic Diseases; D001696:Biomechanical Phenomena; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical
keywords: Aortic valve replacement; Asymptomatic aortic stenosis; Regional strain; Two-dimensional speckle tracking