Incremental value of biventricular strain in patients with severe aortic stenosis

Abstract Background Left ventricular global longitudinal (LVGLS) and right ventricular free wall strain (RVFWS) demonstrated separately prognostic value in patients with severe aortic stenosis (AS). However, studies evaluating combined assessment of LVGLS and RVFWS have shown contradictory results. Aim To explore the prognostic value of combining LVGLS and RVFWS in a large group of severe AS patients referred for transcatheter aortic valve implantation. Methods Patients were classified into three groups: preserved (LVGLS ≥15% AND RVFWS >20%), single-ventricle impaired (LVGLS <15% OR RVFWS ≤20%), or biventricular impaired strain group (LVGLS <15% AND RVFWS ≤20%). Cut-off values were based on previously published data and spline analyses. Endpoint was all-cause mortality. Results Of the 712 patients included (age 80±7 years, 53% men), 248 (35%) died. The single-ventricle impaired and biventricular impaired (vs. preserved) strain groups showed significantly lower 5-year survival rates (68%and 55%vs.77%, respectively, p<0.001; Figure 1). On multivariable analysis, single-ventricle impaired (HR 1.762; 95%CI:1.114-2.788; p=0.015) and biventricular impaired strain groups (HR1.920; 95%CI:1.134-3.250; p=0.015) were independently associated with all-cause mortality. These findings were confirmed by sensitivity analysis in patients with preserved LV ejection fraction (Figure 2). Conclusions In patients with severe AS, biventricular strain allows better risk stratification, even if LV ejection fraction is preserved.