Prognostic value of preprocedural LV global longitudinal strain for post-TAVR-related morbidity and mortality: a meta-analysis

Stens, N.A.; Iersel, O. van; Rooijakkers, M.J.P.; Wely, M.H. van; Nijveldt, R.; Bakker, E.A.; ... ; Thijssen, D.H.J. (2023)

Article / Letter to editor

Background

Left ventricular ejection fraction (LVEF) demonstrates limited prognostic value for post-transcatheter aortic valve replacement (TAVR) outcomes. Evidence regarding the potential role of left ventricular global longitudinal strain (LV-GLS) in this setting is inconsistent.

Objectives

The aim of this systematic review and meta-analysis of aggregated data was to evaluate the prognostic value of preprocedural LV-GLS for post–TAVR-related morbidity and mortality.

Methods

The authors searched PubMed, Embase, and Web of Science for studies investigating the association between preprocedural 2-dimensional speckle-tracking–derived LV-GLS and post-TAVR clinical outcomes. An inversely weighted random effects meta-analysis was adopted to investigate the association between LV-GLS vs primary (ie, all-cause mortality) and secondary (ie, major cardiovascular events [MACE]) post-TAVR outcomes.

Results

Of the 1,130 identified records, 12 were eligible, all of which had a low-to-moderate risk of bias (Newcastle-Ottawa scale). On average, 2,049 patients demonstrated preserved LVEF (52.6% ± 1.7%), but impaired LV-GLS (−13.6% ± 0.6%). Patients with a lower LV-GLS had a higher all-cause mortality (pooled HR: 2.01; 95% CI: 1.59-2.55) and MACE (pooled odds ratio [OR]: 1.26; 95% CI: 1.08-1.47) risk compared with patients with higher LV-GLS. In addition, each percentage point decrease of LV-GLS (ie, toward 0%) was associated with an increased mortality (HR: 1.06; 95% CI: 1.04-1.08) and MACE risk (OR: 1.08; 95% CI: 1.01-1.15).

Conclusions

Preprocedural LV-GLS was significantly associated with post-TAVR morbidity and mortality. This suggests a potential clinically important role of pre-TAVR evaluation of LV-GLS for risk stratification of patients with severe aortic stenosis. (Prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis undergoing Transcatheter Aortic Valve Implantation: a meta-analysis; CRD42021289626

)

• aortic stenosis
• echocardiography
• morbidity
• mortality
• strain
• transcatheter aortic valve replacement

• All authors: Stens, N.A.; Iersel, O. van; Rooijakkers, M.J.P.; Wely, M.H. van; Nijveldt, R.; Bakker, E.A.; Rodwell, L.; Pedersen, A.L.D.; Poulsen, S.H.; Kjonås, D.; Stassen, J.; Bax, J.J.; Tanner, F.C.; Lerakis, S.; Shimoni, S.; Poulin, F.; Ferreira, V.; Luksic, V.R.; Royen, N. van; Thijssen, D.H.J.
• Date: 2023-03-06
• Journal: JACC: Cardiovascular Imaging
• Volume: 16
• Issue: 3
• Pages: 332 - 341
• DOI: doi:10.1016/j.jcmg.2023.01.005
• Link: https://www.sciencedirect.com/science/article/pii/S1936878X23000360?via%...