Prognostic Value of Global Longitudinal Strain in Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis With Preserved Ejection Fraction
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- Sato Kimi
- Cardiovascular Division, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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- Seo Yoshihiro
- Faculty of Medicine, University of Tsukuba
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- Ishizu Tomoko
- Faculty of Medicine, University of Tsukuba
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- Takeuchi Masaaki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
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- Izumo Masaki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
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- Suzuki Kengo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
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- Yamashita Eiji
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
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- Oshima Shigeru
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
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- Akashi Yoshihiro J.
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
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- Otsuji Yutaka
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
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- Aonuma Kazutaka
- Faculty of Medicine, University of Tsukuba
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Description
Background:To assess whether global longitudinal strain (GLS) can discriminate high-risk patients with adverse outcome in paradoxical low-flow, low-gradient (LFLPG) severe aortic stenosis (AS).Methods and Results:We enrolled 204 patients with severe AS (indexed aortic valve area [iAVA] <0.6 cm2/m2) and preserved left ventricular ejection fraction (LVEF >50%). Patients were divided into 4 groups according to flow state (stroke volume index < or > 35 ml/m2) and mean pressure gradient (< or > 40 mmHg). LV GLS was measured by 2-dimensional speckle-tracking analysis. The primary endpoint consisted of major cardiovascular events, including aortic valve replacement. During a mean 399-day follow-up, 51 (25%) patients met the primary endpoint. Among the 98 LFLPG AS patients, GLS was significantly reduced in patients with any event (−15.6±4.5% vs. −19.4±3.6%, P=0.002). Using receiver-operating characteristic analysis, we classified LFLPG AS patients as impaired GLS (GLS ≥−17%, n=24) or preserved GLS (GLS <−17%, n=74). The impaired GLS group had smaller iAVA, higher LV mass index, higher E/E’, and lower overall 2-year event-free survival (57% vs. 97%; P<0.001) than the preserved GLS group.Conclusions:Longitudinal function was severely impaired in patients with LFLPG AS and they had poor prognosis. GLS could stratify the high-risk group for future adverse outcomes. Patients with paradoxical LFLPG AS comprised a mixed group with different LV mechanical properties associated with different prognoses. (Circ J 2014; 78: 2750–2759)
Journal
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- Circulation Journal
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Circulation Journal 78 (11), 2750-2759, 2014
The Japanese Circulation Society
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Details 詳細情報について
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- CRID
- 1390282680084374656
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- NII Article ID
- 130004693850
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- NII Book ID
- AA11591968
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- COI
- 1:STN:280:DC%2BC2M7mtlOnsA%3D%3D
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- ISSN
- 13474820
- 13469843
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- NDL BIB ID
- 025863097
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- PubMed
- 25273913
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- Text Lang
- en
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- Data Source
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- JaLC
- NDL
- Crossref
- PubMed
- CiNii Articles
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- Abstract License Flag
- Disallowed