title: Natural history of severe aortic stenosis: Diastolic wall strain as a novel prognostic marker.
abstract: OBJECTIVE
  Diastolic wall strain (DWS) has been proposed as a simple noninvasive measure of left ventricular (LV) stiffness. This study investigated DWS as a possible predictor of mortality in severe aortic stenosis (AS).
  
  
  METHODS
  138 patients with severe AS (indexed aortic valve area [AVA]<0.6 cm2/m2) and normal ejection fraction (>55%) were included. 52 patients (38%) had aortic valve interventions or poor image quality (n=5) and were excluded leaving 86 in the study group (84±8 years, 70% female, 69% African American). DWS was defined as (LVPWs-LVPWd)/LVPWs where LVPWs=left ventricular posterior wall thickness in systole and LVPWd=left ventricular wall thickness in diastole.
  
  
  RESULTS
  Follow-up extended 2.0±1.9 years (median 1.6 years). Mean DWS for the group was 0.21±0.11 (normal=0.4±0.07). In patients who died, DWS was significantly lower than in survivors (0.18±0.09 vs 0.24±0.11, P=.02). By contrast, traditional measures of diastolic dysfunction did not predict death. Regression analysis showed DWS predicted death even after adjusting for age, sex, race, indexed AVA, symptoms (angina, shortness of breath, dizziness, syncope), and clinical factors (creatinine, smoking, diabetes, hypertension, hyperlipidemia) (HR 2.5 [95% CI 1.02-5.90], P<.05). The best cutoff value for DWS of 0.25 had a sensitivity of 42% and specificity of 83% for predicting death.
  
  
  CONCLUSIONS
  DWS is an independent predictor of all-cause mortality in patients with severe AS, even after accounting for traditional clinical and echocardiographic parameters.
authors.affiliation: Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Edinrin
authors.identifier: http://orcid.org/0000-0002-3165-1792
authors.initials: E
authors.lastname: Obasare
authors.affiliation: Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Bhalla
authors.affiliation: Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Deepakraj
authors.initials: D
authors.lastname: Gajanana
authors.affiliation: Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Rodriguez Ziccardi
authors.affiliation: Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Jose N
authors.initials: JN
authors.lastname: Codolosa
authors.affiliation: Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Figueredo
authors.affiliation: Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Dennis Lynn
authors.initials: DL
authors.lastname: Morris
authors.affiliation: Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Pressman
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: diastolic wall strain; left ventricular stiffness; mortality; severe aortic stenosis