European heart journal. Cardiovascular Imaging · 2025
A novel staging system of cardiac damage in aortic stenosis based on multi-chamber myocardial deformation.
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Tomaselli Michele, Springhetti Paolo, Benfari Giovanni, Penso Marco, Clement Alexandra, Pilan Matteo, Leonardi Denis, Ciceri Luca, Buta Alexandra, Scarsini Roberto, Calin Andreea, Nitu Claudia, Radu Noela, Muraru Denisa, Popescu Bogdan A, Ribichini Flavio, Badano Luigi P
Аннотация
AIMS: This study evaluates whether multi-chamber myocardial deformation analysis using speckle tracking echocardiography (STE) can enhance validated current staging systems and improve risk stratification for patients with moderate-to-severe aortic stenosis (AS).
METHODS AND RESULTS: We reanalysed 2D, Doppler, and STE data obtained from two cohorts: derivation (654 patients, median age: 82 years; 51% men) and validation (237 patients, median age: 77 years; 55% men) with at least moderate AS (aortic valve area < 1.5 cm2). The receiver operator characteristic curve analysis identified optimal cut-off values linked to outcomes: 15% for left ventricular global longitudinal strain (LVGLS), 13% for peak atrial longitudinal strain (PALS), and 19% for right ventricular free-wall strain (RVFWS). Patients have been divided into five stages: Stage 0, no left-side damage (LVGLS ≥ 15% and PALS ≥ 13%); Stage 1, partial left-side damage (LVGLS < 15% or PALS < 13%); Stage 2, definite left-side damage (LVGLS < 15% and PALS < 13%); Stage 3, no right-side damage (RVFWS ≥ 19%); and Stage 4, right-side damage (RVFWS < 19%). In a multivariable Cox regression analysis, the new staging scheme remained independently associated with an increased risk of all-cause death [adjusted-hazard ratio: 1.28; 95% confidence interval (CI): 1.10-1.48; P = 0.001]. This new staging classification exhibited higher predictive power [area under the curve (AUC) 0.67; 95% CI 0.62-0.73] than those proposed by Généreux et al. (Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J 2017;38:3351-8.) (AUC 0.62; 95% CI 0.56-0.67; P = 0.002) and Tastet et al. (Staging cardiac damage in patients with asymptomatic aortic valve stenosis. J Am Coll Cardiol 2019;74:550-63.) (AUC 0.64; 95% CI 0.58-0.70; P = 0.041) for 2-year all-cause death, with similar findings in the validation cohort.
CONCLUSION: Our staging system for detecting cardiac damage, incorporating multi-chamber myocardial deformation, exhibits a stronger association with outcomes than previously validated systems.
METHODS AND RESULTS: We reanalysed 2D, Doppler, and STE data obtained from two cohorts: derivation (654 patients, median age: 82 years; 51% men) and validation (237 patients, median age: 77 years; 55% men) with at least moderate AS (aortic valve area < 1.5 cm2). The receiver operator characteristic curve analysis identified optimal cut-off values linked to outcomes: 15% for left ventricular global longitudinal strain (LVGLS), 13% for peak atrial longitudinal strain (PALS), and 19% for right ventricular free-wall strain (RVFWS). Patients have been divided into five stages: Stage 0, no left-side damage (LVGLS ≥ 15% and PALS ≥ 13%); Stage 1, partial left-side damage (LVGLS < 15% or PALS < 13%); Stage 2, definite left-side damage (LVGLS < 15% and PALS < 13%); Stage 3, no right-side damage (RVFWS ≥ 19%); and Stage 4, right-side damage (RVFWS < 19%). In a multivariable Cox regression analysis, the new staging scheme remained independently associated with an increased risk of all-cause death [adjusted-hazard ratio: 1.28; 95% confidence interval (CI): 1.10-1.48; P = 0.001]. This new staging classification exhibited higher predictive power [area under the curve (AUC) 0.67; 95% CI 0.62-0.73] than those proposed by Généreux et al. (Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J 2017;38:3351-8.) (AUC 0.62; 95% CI 0.56-0.67; P = 0.002) and Tastet et al. (Staging cardiac damage in patients with asymptomatic aortic valve stenosis. J Am Coll Cardiol 2019;74:550-63.) (AUC 0.64; 95% CI 0.58-0.70; P = 0.041) for 2-year all-cause death, with similar findings in the validation cohort.
CONCLUSION: Our staging system for detecting cardiac damage, incorporating multi-chamber myocardial deformation, exhibits a stronger association with outcomes than previously validated systems.