Prognostic Value of Cardiac Magnetic Resonance Feature Tracking Strain in Aortic Stenosis

Vasiliki Tsampasian; Ioannis Merinopoulos; Thuwarahan Ravindrarajah; Liam Ring; Ee Ling Heng; Sanjay Prasad; Vassilios S Vassiliou

doi:10.3390/jcdd11010030

Prognostic Value of Cardiac Magnetic Resonance Feature Tracking Strain in Aortic Stenosis

J Cardiovasc Dev Dis. 2024 Jan 19;11(1):30. doi: 10.3390/jcdd11010030.

Authors

Vasiliki Tsampasian^{1

2}, Ioannis Merinopoulos¹, Thuwarahan Ravindrarajah¹, Liam Ring³, Ee Ling Heng⁴, Sanjay Prasad⁵, Vassilios S Vassiliou²

Affiliations

¹ Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
² Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7UG, UK.
³ Department of Cardiology, West Suffolk Hospital, Hardwick Ln, Bury Saint Edmunds IP33 2QZ, UK.
⁴ Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.
⁵ Faculty of Medicine, Imperial College London, London SW7 5NH, UK.

Abstract

Background: Recent data have suggested that global longitudinal strain (GLS) could be useful for risk stratification of patients with severe aortic stenosis (AS). In this study, we aimed to investigate the prognostic role of GLS in patients with AS and also its incremental value in relation to left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE).

Methods: We analysed all consecutive patients with AS and LGE-CMR in our institution. Survival data were obtained from office of national statistics, a national body where all deaths in England are registered by law. Death certificates were obtained from the general register office.

Results: Some 194 consecutive patients with aortic stenosis were investigated with CMR at baseline and followed up for 7.3 ± 4 years. On multivariate Cox regression analysis, only increasing age remained significant for both all-cause and cardiac mortality, while LGE (any pattern) retained significance for all-cause mortality and had a trend to significance for cardiac mortality. Kaplan-Meier survival analysis demonstrated that patients in the best and middle GLS tertiles had significantly better mortality compared to patients in the worst GLS tertiles. Importantly though, sequential Cox proportional-hazard analysis demonstrated that GLS did not have significant incremental prognostic value for all-cause mortality or cardiac mortality in addition to LVEF and LGE.

Conclusions: Our study has demonstrated that age and LGE but not GLS are significant poor prognostic indicators in patients with moderate and severe AS.

Keywords: aortic stenosis; cardiovascular magnetic resonance; ejection fraction; global longitudinal strain; late gadolinium enhancement.

Grants and funding

This work was supported by the Rosetrees Trust (V.S.V. and S.K.P.), the National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit (CBRU) of Royal Brompton and Harefield NHS Trust and Imperial College London (E.L.H., V.S.V. and S.K.P.) and NIHR Doctoral Research Fellowship (V.T., Ref NIHR303306). The views expressed in this publication are those of the authors and not those of the funders.