INCREMENTAL VALUE OF BIVENTRICULAR STRAIN IN PATIENTS WITH SEVERE AORTIC STENOSIS.

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%), single­ventricle impaired (LVGLS <15%
OR RVFWS ≤20%), or biventricular impaired strain group (LVGLS <15% AND RVFWS ≤20%). Cut­off values were based on
previously published data and spline analyses. Endpoint was all­cause 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 5­year survival rates (68%and 55%vs.77%, respectively, p<0.001; Figure 1). On
multivariable analysis, single­ventricle impaired (HR 1.762; 95%CI:1.114­2.788; p=0.015) and biventricular impaired strain groups
(HR1.920; 95%CI:1.134­3.250; p=0.015) were independently associated with all­cause mortality. These findings were confirmed by
sensitivity analysis in patients with preserved LV ejection fraction.

Conclusions: In patients with severe AS, biventricular strain allows better risk stratification, even if LV ejection fraction is preserved