title: Value of Combined Circumferential and Longitudinal Left Ventricular Systolic Dysfunction to Predict Adverse Outcome in Patients with Asymptomatic Aortic Stenosis.
abstract: BACKGROUND AND AIM OF THE STUDY: Patients with asymptomatic aortic stenosis (AS) may have left ventricular systolic dysfunction (LVSD) defined as an impairment of the circumferential and/or longitudinal (C&L) myocardial fibers, despite a preserved left ventricular ejection fraction (LVEF). An assessment was made as to whether the combined LVSD of C&L fibers has a prognostic impact in asymptomatic AS.
  
  METHODS: A total of 200 asymptomatic AS patients was analyzed. Midwall shortening and mitral annular peak systolic velocity were considered as indices of C&L function and classified as low if <16.5% and <8.5 cm/s, respectively. The primary outcome was a composite of major cardiovascular events (MACE), including aortic valve-related and ischemic cardiovascular-related events.
  
  RESULTS: During a 25-month follow up period, MACE occurred in 69 patients (35%),while 46 of 72 patients (64%) had C&L LVSD and 23 of 128 patients (18%) had not (p <0.001). Cox analysis identified C&L LVSD as an independent MACE predictor, together with aortic transvalvular peak gradient, E/E′ ratio and excessive left ventricular mass. C&L-LVSD also predicted the occurrence of aortic valve-related events and ischemic cardiovascular-related events analyzed separately. A receiver operating characteristic curve analysis showed that the area under the curve (AUC) for C&L LVSD in predicting MACE was 0.77, significantly higher (p = 0.002, z-statistic) than the AUCs of C&L fibers considered individually (0.64 and 0.63, respectively).
  
  CONCLUSION: C&L-LVSD provides additional prognostic information into traditional risk factors for patients with asymptomatic AS.
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, Trento.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.affiliation: Cardiovascular Center, Health Authority no. 1 and University of Trieste.
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.affiliation: Cardiovascular Center, Health Authority no. 1 and University of Trieste.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Division of Cardiology, Department of Medicine, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Vicenza.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nistri
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, Trento.
authors.forename: Federica
authors.initials: F
authors.lastname: Ognibeni
authors.affiliation: Department of Cardiology, Ospedale civile S. Martino, Belluno.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.affiliation: Cardiovascular Center, Health Authority no. 1 and University of Trieste.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Cardiology Unit, Spedali Civili, Brescia.
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.affiliation: Heart Failure Clinic, Division of Cardiology/CCU, San Camillo Hospital, Rome.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, Trento.
authors.forename: Carlo
authors.initials: C
authors.lastname: Stefenelli
authors.affiliation: Department of Translational Medical Sciences, Federico II, University Hospital, School of Medicine, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015992:Body Mass Index; D016022:Case-Control Studies; D004452:Echocardiography; D005500:Follow-Up Studies; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*