A1 Refereed original research article in a scientific journal
Association Between Left Ventricular Apical-to-Basal Strain Ratio and Conduction Disorders after Aortic Valve Replacement
Authors: Laenens Dorien, Stassen Jan, Galloo Xavier, Myagmardorj Rinchyenkhand, Marsan Nina A, Bax Jerome J
Publication year: 2024
Journal: Journal of The American Society of Echocardiography
Journal name in source: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
Journal acronym: J Am Soc Echocardiogr
Volume: 37
Issue: 1
First page : 77
Last page: 86
ISSN: 0894-7317
eISSN: 1097-6795
DOI: https://doi.org/10.1016/j.echo.2023.09.008
Web address : https://doi.org/10.1016/j.echo.2023.09.008
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/181800030
Background: The aim of the study was to evaluate whether left ventricular apical-to-basal longitudinal strain differences, representing advanced basal interstitial fibrosis, are associated with conduction disorders after aortic valve replacement (AVR) in patients with severe aortic stenosis.
Methods: Patients with aortic stenosis undergoing AVR were included. The apical-to-basal strain ratio was calculated by dividing the average strain of the apical segments by the average strain of the basal segments. Values >1.9 were considered abnormal, as previously described. All patients were followed up for the occurrence of complete left or right bundle branch block or permanent pacemaker implantation within 2 years after AVR. Subgroup analysis was performed in patients undergoing transcatheter AVR.
Results: Two hundred seventy-four patients were included (median age of 74 years [interquartile range, 65, 80], 46.4% male). During a median follow-up of 12.2 months (interquartile range, 0.2, 24.3), 74 patients (27%) developed complete bundle branch block or were implanted with a permanent pacemaker. These patients more often had an abnormal apical-to-basal strain ratio. Cumulative event-free survival analysis showed worse outcome in patients with an abnormal apical-to-basal strain ratio (log rank χ2 = 7.258, P = .007). In multivariable Cox regression analysis, an abnormal apical-to-basal strain ratio was the only independent factor associated with the occurrence of complete bundle branch block or permanent pacemaker implantation after adjusting for other factors previously shown to be associated with conduction disorders after AVR. Subgroup analysis confirmed the independent association of an abnormal apical-to-basal strain ratio with conduction disorders after transcatheter AVR.
Conclusion: The apical-to-basal strain ratio is independently associated with conduction disorders after AVR and could guide risk stratification in patients potentially at risk for pacemaker implantation.
Downloadable publication This is an electronic reprint of the original article. |