title: Early Diastolic Strain Rate in Relation to Systolic and Diastolic Function and Prognosis in Aortic Stenosis.
abstract: This study examined the impact of early mitral inflow velocity-to-early diastolic strain rate (E/SRe) ratio on long-term outcome after aortic valve replacement (AVR) in aortic stenosis (AS).
  
  
  
  In AS, increased filling pressures are associated with a poor prognosis and can be estimated using the early diastolic mitral inflow velocity-to-early diastolic velocity of the mitral annulus (E/e') ratio. Recent studies suggest that the E/SRe ratio surpasses the E/e' ratio in estimating outcome.
  
  
  
  Pre-operative evaluation was performed in 121 patients with severe AS (aortic valve area <1 cm(2)) and left ventricular ejection fraction (LVEF) of >40% who were scheduled for AVR. Patients were divided according to E/SRe median and followed for 5 years. The primary endpoint was overall mortality.
  
  
  
  LVEF was lower (53 ± 7% vs. 56 ± 7%, respectively; p = 0.03) and a restrictive filling pattern more common (28% vs. 8%, respectively, p = 0.005) in patients with increased E/SRe ratio. Five-year overall mortality was increased in patients with high E/SRe (40% vs. 15%, respectively; p = 0.007). In univariate Cox regression analysis, E/SRe, age, European System for Cardiac Operative Risk Evaluation (EuroSCORE), LV mass index, left atrial volume index, LVEF, global longitudinal strain, E/e' ratio, and N-terminal pro-B-type natriuretic peptide level were univariate predictors of overall mortality, although when we adjusted for the predefined variables age, history of diabetes mellitus and LVEF, only E/SRe and left atrial volume index remained associated with overall mortality. Even when we included left atrial volume index in the multivariate model, E/SRe was significantly associated with overall mortality (hazard ratio [HR]: 2.2; 95% confidence interval [CI]: 1.1 to 4.4; p < 0.05); additionally, in a model with forward selection, E/SRe was the sole predictor (HR: 2.9; 95% CI: 1.6 to 5.5; p = 0.001. The overall log likelihood chi-square analysis of the predictive power of the multivariate model containing E/SRe was statistically superior to models based on the E/e' ratio.
  
  
  
  Pre-operative E/SRe ratio was significantly associated with long-term post-operative survival and was superior to the E/e' ratio in patients with severe AS undergoing AVR. (Effect of Angiotensin II Receptor Blockers (ARB) on Left Ventricular Reverse Remodelling After Aortic Valve Replacement in Severe Valvular Aortic Stenosis; NCT00294775).
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: jordidahl@gmail.com.
authors.forename: Jordi S
authors.initials: JS
authors.lastname: Dahl
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sergio
authors.initials: S
authors.lastname: Barros-Gomes
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Videbæk
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Mikael K
authors.initials: MK
authors.lastname: Poulsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Issa F
authors.initials: IF
authors.lastname: Issa
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Carter-Storch
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Nicolaj Lyhne
authors.initials: NL
authors.lastname: Christensen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Kumme
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Møller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D003718:Denmark; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: aortic stenosis; echocardiography; prognosis; strain imaging; valves