Prognostic Value of Preprocedural LV Global Longitudinal Strain for Post-TAVR-Related Morbidity and Mortality: A Meta-Analysis

Niels A Stens; Odette van Iersel; Max J P Rooijakkers; Marleen H van Wely; Robin Nijveldt; Esmée A Bakker; Laura Rodwell; Anders L D Pedersen; Steen H Poulsen; Didrik Kjønås; Jan Stassen; Jeroen J Bax; Felix C Tanner; Stamatios Lerakis; Sara Shimoni; Frédéric Poulin; Vera Ferreira; Vlatka Reskovic Luksic; Niels van Royen; Dick H J Thijssen

doi:10.1016/j.jcmg.2023.01.005

Prognostic Value of Preprocedural LV Global Longitudinal Strain for Post-TAVR-Related Morbidity and Mortality: A Meta-Analysis

JACC Cardiovasc Imaging. 2023 Mar;16(3):332-341. doi: 10.1016/j.jcmg.2023.01.005.

Authors

Niels A Stens¹, Odette van Iersel², Max J P Rooijakkers³, Marleen H van Wely³, Robin Nijveldt³, Esmée A Bakker², Laura Rodwell⁴, Anders L D Pedersen⁵, Steen H Poulsen⁵, Didrik Kjønås⁶, Jan Stassen⁷, Jeroen J Bax⁸, Felix C Tanner⁹, Stamatios Lerakis¹⁰, Sara Shimoni¹¹, Frédéric Poulin¹², Vera Ferreira¹³, Vlatka Reskovic Luksic¹⁴, Niels van Royen³, Dick H J Thijssen¹⁵

Affiliations

¹ Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
² Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
³ Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
⁴ Department of Health Evidence, section of Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
⁵ Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
⁶ Department of General and Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway.
⁷ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
⁸ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
⁹ Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
¹⁰ Department of Cardiology, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹¹ The Heart Center, Kaplan Medical Center, Rehovot, Israel.
¹² Division of Cardiology, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.
¹³ Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Lisbon, Portugal.
¹⁴ Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Zagreb, Croatia.
¹⁵ Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom. Electronic address: Dick.Thijssen@radboudumc.nl.

PMID: 36889849
DOI: 10.1016/j.jcmg.2023.01.005

Abstract

Background: Left ventricular ejection fraction (LVEF) demonstrates limited prognostic value for post-transcatheter aortic valve replacement (TAVR) outcomes. Evidence regarding the potential role of left ventricular global longitudinal strain (LV-GLS) in this setting is inconsistent.

Objectives: The aim of this systematic review and meta-analysis of aggregated data was to evaluate the prognostic value of preprocedural LV-GLS for post-TAVR-related morbidity and mortality.

Methods: The authors searched PubMed, Embase, and Web of Science for studies investigating the association between preprocedural 2-dimensional speckle-tracking-derived LV-GLS and post-TAVR clinical outcomes. An inversely weighted random effects meta-analysis was adopted to investigate the association between LV-GLS vs primary (ie, all-cause mortality) and secondary (ie, major cardiovascular events [MACE]) post-TAVR outcomes.

Results: Of the 1,130 identified records, 12 were eligible, all of which had a low-to-moderate risk of bias (Newcastle-Ottawa scale). On average, 2,049 patients demonstrated preserved LVEF (52.6% ± 1.7%), but impaired LV-GLS (-13.6% ± 0.6%). Patients with a lower LV-GLS had a higher all-cause mortality (pooled HR: 2.01; 95% CI: 1.59-2.55) and MACE (pooled odds ratio [OR]: 1.26; 95% CI: 1.08-1.47) risk compared with patients with higher LV-GLS. In addition, each percentage point decrease of LV-GLS (ie, toward 0%) was associated with an increased mortality (HR: 1.06; 95% CI: 1.04-1.08) and MACE risk (OR: 1.08; 95% CI: 1.01-1.15).

Conclusions: Preprocedural LV-GLS was significantly associated with post-TAVR morbidity and mortality. This suggests a potential clinically important role of pre-TAVR evaluation of LV-GLS for risk stratification of patients with severe aortic stenosis. (Prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis undergoing Transcatheter Aortic Valve Implantation: a meta-analysis; CRD42021289626).

Keywords: aortic stenosis; echocardiography; morbidity; mortality; strain; transcatheter aortic valve replacement.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / surgery
Global Longitudinal Strain
Humans
Predictive Value of Tests
Prognosis
Retrospective Studies
Stroke Volume
Transcatheter Aortic Valve Replacement* / adverse effects
Ventricular Dysfunction, Left*
Ventricular Function, Left