Table 2.
Independent predictors of adverse events in patients with aortic stenosis - results of studies assessing modern echocardiographic parameters
| Independent predictors | Cut-off values | Population | Adverse events | Follow-up | Reference |
|---|---|---|---|---|---|
| - Basal longitudinal strain (STE) | −13% | - 65 asymptomatic pts with AS, AVA < 1 cm2, LVEF >55% | Combined end-point: re-hospitalization for any cardiac cause, aortic valve surgery, cardiovascular death within 12 months | 12 months | Lafitte et al. [5] |
| - Systolic annular velocity (TDI) | - 126 asymptomatic pts with AVA ≤ 1,2 cm2, LVEF >55% | Combined end point: onset of symptoms; cardiac-related death; need for AVR | 20.3 ± 17.8 months (median follow-up period) | Lancellotti et al. [64] | |
| - Late diastolic annular velocity (TDI) | |||||
| - E/e' ratio | |||||
| - Indexed LA area | |||||
| - BNP | |||||
| - LV longitudinal deformation (STE) | - 15.9% | - 163 asymptomatic pts with AVAi < 0.06 cm2/m2; LVEF >55% | Combined end-point: cardiac death; development of significant symptoms; clinical need of AVR | 20 ± 19 months | Lancellotti et al. [65] |
| - Peak aortic jet velocity | 4.4 m/s | ||||
| - Valvuloarterial impedance | 4.9 mmHg/ml/m2 | ||||
| 12.2 cm2/m2 | |||||
| - Indexed LA area | |||||
| - Global LV longitudinal strain (STE) | −15% | - 79 asymptomatic patients with severe AS (AVA <1 cm2 or transaortic jet velocity >4 m/s) and LVEF ≥ 50% | Combined end-point: cardiac death; AVR driven by symptom development | 23 ± 20 months | Yingchoncharoen et al. [66] |
| - STS-PRMM | |||||
| - Aortic valve calcification score | |||||
| - AVA | |||||
| - Valvuloarterial impedance | |||||
| - E/e’ ratio (lateral annular site) | 15 | - 125 symptomatic and asymptomatic unoperated patients with severe AS | All cause death | 1 year | Biner et al. [67] |
| - BNP | 300 ng/ml | ||||
| - Global LV longitudinal strain (STE) | −15% (−12.8%*) | - 146 symptomatic and asymptomatic pts with mild, moderate and severe AS | All-cause mortality | median follow-up of 2.1 years | Kearney et al. [68] |
| - Age-adjusted Charlson comorbidity | |||||
| Index | |||||
| - Symptom severity class | |||||
| - Systolic peak radial strain rate (TDI) | 2/s | - 32 symptomatic patients with AVR for severe AS (AVA < 1 cm2, LVEF 61 ± 10% ) | Combined end-point: cardiovascular death, worsening of HF and limited exercise capacity | 12 months | Bauer et al. [69] |
| - e' | |||||
| - E/Vp | |||||
| - Global LV longitudinal strain (STE)** | - 125 symptomatic pts with severe AS and LVEF >40% undergoing AVR | Combined end point: cardiovascular mortality and cardiac hospitalization due to worsening of HF | mean follow-up of 3.8 ± 1.5 years | Dahl et al.[70] |
TDI, Tissue Doppler imaging; STE, speckle tracking echocardiography; AVA, aortic valve area; AVAi, indexed aortic valve area; LVEF, left ventricular ejection fraction; LA, left atrium; STS-PRMM, Society of Thoracic Surgeons Predicted Risk of Morbidity and Mortality; E, early diastolic transmitral velocity; e’, mitral annulus early diastolic velocity, Vp, velocity of flow propagation into the left ventricle.
*, this threshold provided the best combination of sensitivity (83%) and specificity (87%) for all-cause mortality.
**, patients were divided into 4 groups according to GLS quartiles.