The Relative Apical Sparing Strain Pattern in Severe Aortic Valve Stenosis: A Marker of Adverse Cardiac Remodeling
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Inclusion/Exclusion Criteria
2.3. Cardiac Imaging
2.3.1. Echocardiography
2.3.2. CMR Protocol
2.4. Histological Analysis
2.5. Statistical Analysis
2.6. Intra-Observer and Inter-Observer Variability Analysis
3. Results
3.1. Study Cohort Data
3.2. Data Comparison between Patients with and without an RAS Strain Pattern
3.3. Follow-Up Echocardiography Data
4. Discussion
4.1. CA Links with AS
4.2. Consequences of AS-Induced Remodeling
4.3. GLS as a Prognostic Marker
4.4. RAS Strain Pattern after SAVR
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AS | aortic stenosis |
ATTR-CA | transthyretin cardiac amyloidosis |
AV | aortic valve |
AVA | aortic valve area |
SAVR | surgical aortic valve replacement |
BNP | brain natriuretic peptide |
BSA | body surface area |
CA | cardiac amyloidosis |
CAD | coronary artery disease |
CKD | chronic kidney disease |
CVF | collagen volume fraction |
CMR | cardiovascular magnetic resonance |
ECG | electrocardiography |
ECV | extracellular volume |
GLS | global longitudinal strain |
Hs–Tn–I | high-sensitivity troponin I |
LGE | late gadolinium enhancement |
LV | left ventricle |
LVEF | left ventricular ejection fraction |
MI | myocardial infarction |
NYHA | New York Heart Association |
RAS | relative apical sparing |
STE | speckle-tracking echocardiography |
TAVI | transcatheter aortic valve implantation |
T1 | T1 myocardial relaxation |
References
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Variables | All Patients (n = 77) | RAS Strain Pattern-Positive Patients (n = 14) | RAS Strain Pattern-Negative Patients (n = 63) | p-Value | |
---|---|---|---|---|---|
Age, years | 70 (62–73) | 67 (63–71) | 71 (62–73) | 0.415 | |
Sex, female | 45 (58) | 9 (64) | 36 (57) | 0.849 | |
BSA, m2 | 1.9 ± 0.2 | 1.9 ± 0.1 | 1.9 ± 0.2 | 0.822 | |
Comorbidities | |||||
Hypertension | 69 (90) | 13 (92) | 56 (88) | 0.597 | |
Dyslipidemia | 61 (79) | 9 (64) | 52 (83) | 0.128 | |
Unobstructive CAD | 30 (39) | 4 (29) | 26 (41) | 0.378 | |
Diabetes mellitus | 12 (16) | 4 (27) | 8 (13) | 0.139 | |
Atrial fibrillation | 2 (3) | 0 (0) | 2 (3) | 0.499 | |
Symptoms and functional status | |||||
Dyspnoea | 54 (70) | 9 (64) | 45 (71) | 0.597 | |
Chest pain | 35 (47) | 8 (57) | 27 (45) | 0.413 | |
Syncope | 8 (10) | 3 (21) | 5 (8) | 0.135 | |
6MWT, m | 369 (300–420) | 318 (284–399) | 369 (332–420) | 0.220 | |
NYHA functional class | I | 15 (19) | 1 (7) | 14 (22) | 0.561 * |
II | 22 (29) | 5 (36) | 17 (27) | ||
III | 37 (48) | 8 (57) | 29 (46) | ||
IV | 3 (4) | 0 (0) | 3 (5) | ||
Risk scores | |||||
STS-PROM, % | 1.6 (1.2–2.4) | 1.8 (1.4–2.2) | 1.6 (1.0–2.5) | 0.629 | |
EuroSCORE II, % | 1.1 (0.7–1.6) | 1.0 (0.8–1.5) | 1.1 (0.7–1.7) | 0.771 | |
ECG parameters | |||||
S–L voltage index, mm | 31.2 ± 10 | 35.8 (29.5–44) | 30.1 (23–37.8) | 0.058 | |
QRS duration, ms | 94 (86–102) | 96.0 ± (92.5–102.0) | 91.0 (86.0–99.5) | 0.224 | |
Echocardiography data | |||||
AV area index, cm2/m2 | 0.45 ± 0.1 | 0.41 ± 0.1 | 0.45 ± 0.1 | 0.163 | |
Peak AV velocity, m/s | 4.9 ± 0.6 | 5.3 ± 0.7 | 4.8 ± 0.6 | 0.005 | |
Mean AV gradient, mmHg | 54.9 (45–70) | 70 ± 20 | 56 ± 14 | 0.013 | |
Low gradient AS | 8 (10) | 1 (7) | 7 (11) | 0.660 | |
IVSd, mm | 12.8 ± 1.7 | 14.6 ± 1.1 | 12.4 ± 1.5 | <0.001 | |
LVEdd, mm | 50 (47–55) | 51.8 ± 4.4 | 51.2 ± 5.6 | 0.384 | |
LVEsd, mm | 32 (29–35) | 34.5 ± 6 | 32 ± 6 | 0.124 | |
E/A ratio | 1.2 ± 0.5 | 1.4 ± 0.6 | 1.1 ± 0.4 | 0.042 | |
E deceleration time, ms | 245 (212–308) | 223 (200–265) | 251 (223–314) | 0.190 | |
Posterior wall diameter, mm | 12 (10–12) | 12 (12–14) | 11 (10–12) | 0.001 | |
E/e’ septal | 17 (13–21) | 17.1 (16–18) | 16 (13–20) | 0.238 | |
E/e’ lateral | 13 (11–17) | 15 (11–17) | 13 (11–17) | 0.804 | |
E/e’ mean | 15 (12–18) | 16 ± 7 | 16 ± 6 | 0.717 | |
LA volume index, mL/m2 | 48.6 ± 12 | 52 ± 14 | 48 ± 12 | 0.253 | |
PASP, mmHg | 33 (29–42) | 39 ± 18 | 38 ± 14 | 0.826 | |
RV S’, cm/s | 12 (10–13) | 12 (10–13) | 11 (10–13) | 0.771 | |
TAPSE | 22 ± 3 | 21 ± 3 | 22 ± 3 | 0.057 | |
GLS, % | −18 ± 5 | −14.9 ± 3 | −18.7 ± 5 | 0.002 | |
GLS >−15% | 16 (21) | 7 (50) | 9 (14) | 0.006 | |
CMR data | |||||
IVSd, mm | 13.3 (12–15) | 14.8 ± 1 | 12.9 ± 2 | 0.004 | |
LVEdd, mm | 50.4 ± 6 | 54 ± 4 | 50 ± 6 | 0.006 | |
LVEsd, mm | 33.6 ± 8 | 37 ± 7 | 33 ± 8 | 0.140 | |
LVEDV, mL | 136 (113–160) | 149 ± 30 | 143 ± 348 | 0.265 | |
LVESV, mL | 41.5 (28–61) | 56 (46–73) | 36 (26–56) | 0.062 | |
LV stroke volume index, mL/m2 | 46 (42–53) | 44 (43–48) | 47 (41–55) | 0.452 | |
LVEF, % | 69.6 (61–75) | 62 ± 12 | 68 ± 13 | 0.040 | |
LVEF < 50% | 8 (10) | 8 (20) | 0 (0) | 0.089 | |
LV mass index, g/m2 | 91.3 (76–119) | 125 ± 28 | 91 ± 32 | 0.001 | |
RVEDV, mL | 120 (108–140) | 119 (103–136) | 120 (109–140) | 0.734 | |
RVESV, mL | 44 (36–59) | 40 (30–52) | 45 (37–59) | 0.163 | |
RVEF, % | 62.9 (57–67) | 64.7 (61–72) | 61.7 (57–66) | 0.119 | |
Native T1, ms | 959.2 ± 34 | 971 ± 36 | 956 ± 33 | 0.156 | |
Post-contrast T1, ms | 352 (327–363) | 353 (332–363) | 351 (327–361) | 0.533 | |
LGE prevalence | 57 (74) | 34 (85) | 23 (62) | 0.175 | |
ECV, % | 22.6 ± 3 | 23.4 ± 3 | 22.3 ± 3 | 0.292 | |
ECV index, %/m2 | 12 (11–13) | 13 (12–13) | 12 (11–13) | 0.454 | |
Histology data (n = 71) | |||||
CVF, % | 12.4 (8–22) | 10.8 (7–17) | 15.9 (8–23) | 0.232 | |
CVF subendocardial, % | 21.8 (10–35) | 17.4 (9–24) | 21.8 (12–38) | 0.108 | |
Surgery | |||||
Tissue valve | 71 (92) | 14 (100) | 57 (91) | 0.229 | |
Mechanical valve | 6 (8) | 0 (0) | 6 (10) | 0.229 | |
Aortic intervention | 2 (3) | 0 (0) | 2 (3) | 0.499 | |
Serum biomarkers | |||||
BNP, pg/L | 142 (67–362) | 409 (161–961) | 119 (66–245) | 0.032 | |
Hs-Tn-I, pg/L | 10 (5–18) | 15 (13–29) | 9 (5–18) | 0.026 | |
Creatinine, μmol/L | 76 ± 16 | 73 ± 17 | 76 ± 16 | 0.491 | |
eGFR, mL/min/1.73 m2 | 85 (69–90) | 87 (71–90) | 85 (70–90) | 0.533 |
Echocardiography Data | Baseline (n = 14) | 3-Month Follow-Up (n = 14) | 12-Month Follow-Up (n = 14) | p-Value |
---|---|---|---|---|
AV area index, cm2/m2 | 0.4 ± 0.1 | 1.3 ± 0.3 | 1.2 ± 0.3 | <0.001 |
Peak AV velocity, m/s | 5.3 ± 0.7 | 2.2 ± 0.4 | 2.3 ± 0.4 | <0.001 |
Mean AV gradient, mm Hg | 65.3 (56.2–84.1) | 9.25 (8.0–10.8) | 10.4 (8.2–12.6) | <0.001 |
IVSd, mm | 14.5 (14.0–15.0) | 11.5 (11.0–14.0) | 11.5 (11.0–12.0) | <0.001 |
LVEdd, mm | 51.5 (49.0–54.5) | 50.5 (48.5–53.8) | 50.0 (46.5–52.0) | 0.699 |
LVEsd, mm | 34.2 ± 5.7 | 33.8 ± 5.9 | 31.9 ± 3.6 | 0.131 |
E/e’ septal | 17.6 (16.1–20.1) | 16.6 (11.4–18.2) | 15.6 (12.7–21.5) | 0.092 |
E/e’ lateral | 14.7 (11.2–17.0) | 8.43 (6.56–10.8) | 8.88 (6.60–11.8) | 0.011 |
E/e’ mean | 17.1 ± 7.2 | 11.7 ± 3.7 | 11.9 ± 4.5 | 0.004 |
LA volume index, mL/m2 | 52.0 ± 13.4 | 45.4 ± 8.5 | 43.0 ± 10.8 | 0.009 |
RV S’, cm/s | 12 (10–13) | 9 (8–10) | 9 (9–11) | 0.009 |
GLS, % | 14.9 ± 3 | 18.3 ± 2 | 19.7 ± 2 | <0.001 |
RAS strain pattern, n (%) | 14 (100) | 0 (0) | 0 (0) | – |
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Ramanauskaitė, D.; Balčiūnaitė, G.; Palionis, D.; Besusparis, J.; Žurauskas, E.; Janušauskas, V.; Zorinas, A.; Valevičienė, N.; Sogaard, P.; Glaveckaitė, S. The Relative Apical Sparing Strain Pattern in Severe Aortic Valve Stenosis: A Marker of Adverse Cardiac Remodeling. J. Pers. Med. 2024, 14, 707. https://doi.org/10.3390/jpm14070707
Ramanauskaitė D, Balčiūnaitė G, Palionis D, Besusparis J, Žurauskas E, Janušauskas V, Zorinas A, Valevičienė N, Sogaard P, Glaveckaitė S. The Relative Apical Sparing Strain Pattern in Severe Aortic Valve Stenosis: A Marker of Adverse Cardiac Remodeling. Journal of Personalized Medicine. 2024; 14(7):707. https://doi.org/10.3390/jpm14070707
Chicago/Turabian StyleRamanauskaitė, Dovilė, Giedrė Balčiūnaitė, Darius Palionis, Justinas Besusparis, Edvardas Žurauskas, Vilius Janušauskas, Aleksejus Zorinas, Nomeda Valevičienė, Peter Sogaard, and Sigita Glaveckaitė. 2024. "The Relative Apical Sparing Strain Pattern in Severe Aortic Valve Stenosis: A Marker of Adverse Cardiac Remodeling" Journal of Personalized Medicine 14, no. 7: 707. https://doi.org/10.3390/jpm14070707