Tissue-tracking mitral annular displacement predicts impaired left ventricular mechanics and adverse outcomes in aortic stenosis with preserved left ventricular ejection fraction.

AIMS: Tissue-tracking mitral annular displacement (TMAD) is a simple marker for left ventricular (LV) systolic function. However, its clinical impact in aortic stenosis (AS) remains unclear. We aimed to investigate the significance of TMAD on LV mechanics in comparison with global longitudinal strain (GLS) and its prognostic value in AS.

METHODS

We retrospectively reviewed 91 patients with moderate or severe AS and preserved LV ejection fraction (≥ 50 %). TMAD was measured from an apical four-chamber view and indexed to the LV long-axis length (%TMAD). The associations between TMAD and LV ejection fraction (LVEF) and GLS, including the regional distribution (apical, mid, and basal) of longitudinal strain (LS), were evaluated. We also assessed the impact of %TMAD on clinical outcomes, including cardiovascular death, heart failure hospitalization, and unplanned aortic valve replacement.

RESULTS

%TMAD showed a moderate correlation with LVEF (r = 0.45, P < 0.001) and a strong correlation with |GLS| (r = 0.81, P < 0.001). In the regional LS analysis, %TMAD correlated strongly with mid and basal LS, but modestly with apical. The cutoff value of %TMAD for predicting impaired GLS (|GLS| < 14.7 %, as previously reviewed) was 9.8 %, which also predicted event-free survival (Log-rank P = 0.001). In a Cox proportional hazards model, lower %TMAD was significantly associated with worse clinical outcomes, independent of AS severity and LVEF.

CONCLUSIONS

%TMAD is a marker of LV longitudinal systolic function, particularly reflecting mid-basal longitudinal systolic function, and can be a useful prognosticator in AS patients.