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J. Clin. Med. 2019, 8(2), 165; https://doi.org/10.3390/jcm8020165

Incremental Predictive Value of Longitudinal Axis Strain and Late Gadolinium Enhancement Using Standard CMR Imaging in Patients with Aortic Stenosis

1
2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
2
Affidea Hiperdia Diagnostic Imaging Center, 400015 Cluj-Napoca, Romania
3
Niculae Stancioiu Heart Institute, 400001 Cluj-Napoca, Romania
4
5th Department of Internal Medicine, University of Medicine and Pharmacy of Tirgu Mures, 540139 Tirgu Mures, Romania
5
Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
*
Author to whom correspondence should be addressed.
Received: 26 December 2018 / Revised: 22 January 2019 / Accepted: 30 January 2019 / Published: 1 February 2019
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Abstract

To analyse the predictive ability and incremental value of left ventricular longitudinal axis strain (LAS) and late gadolinium enhancement (LGE) using standard cardiovascular magnetic resonance (CMR) imaging for the diagnosis and prognosis of severe aortic stenosis (AS) in patients with an indication for aortic valve replacement. We conducted a prospective study on 52 patients with severe AS and 52 volunteers. The evaluation protocol included standard biochemistry tests, novel biomarkers of myocardial fibrosis, 12-lead electrocardiograms and 24-hour Holter, the 6-minute walk test and extensive echocardiographic and CMR imaging studies. Outcomes were defined as the composite of major cardiovascular events (MACEs). Among AS patients, most (n = 17, 77.2%) of those who exhibited LGE at CMR imaging had MACEs during follow-up. Kaplan–Meier curves for event-free survival showed a significantly higher rate of MACEs in patients with LGE (p < 0.01) and decreased LAS (p < 0.001). In Cox regression analysis, only reduced LAS (hazard ratio 1.33, 95% CI (1.01 to 1.74), p < 0.01) and the presence of LGE (hazard ratio 11.3, 95% CI (1.82 to 70.0), p < 0.01) were independent predictors for MACEs. The predictive value increased if both LGE and reduced LAS were added to left ventricular ejection fraction (LVEF). None of the biomarkers of increased collagen turnover exhibited any predictive value for MACEs. LAS by CMR is an independent predictor of outcomes in patients with AS and provides incremental value beyond the assessment of LVEF and the presence of LGE. View Full-Text
Keywords: severe aortic stenosis; longitudinal axis strain; late gadolinium enhancement; cardiac magnetic resonance imaging severe aortic stenosis; longitudinal axis strain; late gadolinium enhancement; cardiac magnetic resonance imaging
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Agoston-Coldea, L.; Bheecarry, K.; Cionca, C.; Petra, C.; Strimbu, L.; Ober, C.; Lupu, S.; Fodor, D.; Mocan, T. Incremental Predictive Value of Longitudinal Axis Strain and Late Gadolinium Enhancement Using Standard CMR Imaging in Patients with Aortic Stenosis. J. Clin. Med. 2019, 8, 165.

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