Prognostic value of left ventricular myocardial strain in asymptomatic patients with severe aortic stenosis

doi:10.3877/cma.j.issn.1672-6448.2023.06.002

Abstract

Abstract:

Objective

To assess the predictive value of left ventricular myocardial strain parameters for major adverse cardiovascular events (MACE) in patients with asympomatic severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF).

Methods

A total of 68 asymptomatic severe AS patients with preserved LVEF (LVEF≥50%) detected by routine echocardiography at the Second Affiliated Hospital of Nanchang University from January 2018 to April 2020 were included. Clinical data, conventional echocardiographic parameters, and left ventricular strain parameters obtained by two-dimensional and three-dimensional spot tracking imaging were obtained. All subjects were followed at 3-month intervals for 18 months. According to whether the subjects developed MACE during the follow-up period, they were divided into a group with MACE or a group without MACE. The independent predictors of MACE occurrence were analyzed using the Cox proportional risk model. The ROC curve was drawn, the area under the curve for predicting MACE occurrence by independent correlation parameters was calculated, and the optimal diagnostic threshold value, sensitivity, and specificity were obtained.

Results

Two-dimensional left ventricular global longitudinal strain (2D-LVGLS) and three-dimensional left ventricular global longitudinal strain (3D-LVGLS) were independent predictors of MACE; the area under the ROC curve was 0.752 and 0.851, respectively. Using -15.2% as the cut-off value of 2D-LVGLS, its sensitivity and specificity for predicting MACE were 65% and 68%, respectively. Using -14.5% as the cut-off value of 3D-LVGLS, its sensitivity and specificity for predicting the occurrence of MACE were 76% and 73%, respectively.

Conclusion

Three-dimensional speck tracking technique to assess left ventricular myocardial strain can quantitatively predict the occurrence of MACE in asymptomatic severe AS patients with preserved LVEF, and its predictive performance is slightly better than that of two-dimensional speckle tracking strain parameters, thus providing a basis for early clinical intervention of this condition.

Key words: Speckle tracking imaging, Echocardiography, Myocardial strain, Aortic stenosis, Major adverse cardiovascular events, Prognosis

Kang Ying, Canying Yang, Fengzhen Liu, Lili Chen, Yanna Liu. Prognostic value of left ventricular myocardial strain in asymptomatic patients with severe aortic stenosis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 581-587.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.06.002

https://chaosheng.cma-cmc.com.cn/EN/Y2023/V20/I06/581

Figures/Tables 7

临床资料	合计（68例）	发生MACE组（21例）	未发生MACE组（47例）	统计值	P值
年龄（岁， $x ¯$ ±s）	71.6±8.4	71.7±7.2	71.6±8.3	t=1.273	0.362
男性［例（%）］	41（60.2）	13（61.9）	28（59.6）	χ²=27.34	0.552
BSA（m²， $x ¯$ ±s）	1.51±0.15	1.50±0.11	1.51±0.08	t=0.579	0.681
高血压［例（%）］	42（61.8）	13（61.9）	29（61.7）	χ²=23.54	0.774
高血脂［例（%）］	33（48.5）	10（47.6）	23（48.9）	χ²=21.67	0.876
慢性肾病［例（%）］	27（39.7）	8（38.1）	19（40.4）	χ²=17.69	0.974
冠心病［例（%）］	19（27.9）	6（28.5）	13（27.6）	χ²=22.42	0.836
糖尿病［例（%）］	16（23.5）	5（23.8）	12（25.5）	χ²=28.63	0.548

临床资料	合计（68例）	发生MACE组（21例）	未发生MACE组（47例）	统计值	P值
年龄（岁， $x ¯$ ±s）	71.6±8.4	71.7±7.2	71.6±8.3	t=1.273	0.362
男性［例（%）］	41（60.2）	13（61.9）	28（59.6）	χ²=27.34	0.552
BSA（m²， $x ¯$ ±s）	1.51±0.15	1.50±0.11	1.51±0.08	t=0.579	0.681
高血压［例（%）］	42（61.8）	13（61.9）	29（61.7）	χ²=23.54	0.774
高血脂［例（%）］	33（48.5）	10（47.6）	23（48.9）	χ²=21.67	0.876
慢性肾病［例（%）］	27（39.7）	8（38.1）	19（40.4）	χ²=17.69	0.974
冠心病［例（%）］	19（27.9）	6（28.5）	13（27.6）	χ²=22.42	0.836
糖尿病［例（%）］	16（23.5）	5（23.8）	12（25.5）	χ²=28.63	0.548

超声参数	合计（68例）	发生MACE组（21例）	未发生MACE组（47例）	t值	P值
Vmax（m/s）	4.56±0.29	4.82±0.25	4.45±0.22	2.852	0.011
MPG（mmHg）	48.91±14.54	51.29±13.93	47.40±13.98	2.719	0.017
AVAI（cm²/m²）	0.45±0.17	0.42±0.14	0.47±0.21	2.973	0.005
LVEDd（mm）	46.52±5.21	44.3±4.61	45.7±5.32	0.785	0.724
LVMI（g/m²）	86.34±28.09	92.01±36.21	87.94±39.12	1.854	0.068
LAVI（ml/m²）	37.95±5.13	38.11±4.38	37.64±2.99	1.109	0.323
LVEF（%）	61.52±3.06	60.28±4.53	61.95±5.92	1.541	0.172
E/e'-IVS	11.92±2.92	12.32±6.6	11.56±7.2	0.916	0.687
2D-LVGLS（%）	-15.23±2.71	-13.52±2.57	-16.16±2.52	3.306	0.002
3D-LVGLS（%）	-13.91±2.29	-12.57±1.75	-14.77±2.14	11.582	＜0.001
3D-LVGCS（%）	-24.19±3.25	-23.38±3.44	-24.26±3.17	1.275	0.309
3D-LVGRS（%）	34.38±4.54	32.62±2.47	35.40±2.94	2.286	0.044
3D-LVGAS（%）	-28.33±3.63	-27.84±2.97	-28.83±4.37	0.617	0.923

因素	HR	95%CI	P值
Vmax	1.030	0.976~1.254	0.113
MPG	0.982	0.849~1.136	0.808
AVAI	0.904	0.827~1.219	0.728
2D-LVGLS	0.914	0.849~0.914	0.028
3D-LVGLS	2.292	1.587~3.310	＜0.001
3D-LVGRS	1.047	0.924~1.188	0.470

参数	样本量	测值1	测值2	偏倚	ICC
2D-LVGLS	20	-15.23±3.03	-15.31±2.96	-0.06±1.04	0.89
3D-LVGLS	20	-13.93±3.03	-13.91±2.96	-0.02±1.02	0.86
3D-LVGCS	20	-28.73±2.92	-28.75±2.95	-0.12±1.65	0.87
3D-LVGRS	20	37.29±3.54	37.28±3.53	-0.08±1.92	0.90
3D-LVGAS	20	-21.83±2.62	-21.92±2.76	-0.15±2.21	0.80

参数	样本量	观察者1	观察者2	偏倚	ICC
2D-LVGLS	20	-15.23±3.03	-15.26±2.92	-0.07±1.08	0.88
3D-LVGLS	20	-13.93±3.03	-13.89±2.96	0.03±1.15	0.80
3D-LVGRS	20	-28.73±2.92	-28.74±2.95	0.13±1.76	0.85
3D-LVGCS	20	37.29±3.54	37.27±3.33	0.09±2.08	0.83
3D-LVGAS	20	-21.83±2.62	-21.86±2.76	0.05±2.1	0.82

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