Left Ventricular Global Longitudinal Strain Is Associated with Long-Term Outcomes in Moderate Aortic Stenosis

Dan Zhu, Saki Ito, William R. Miranda, Vuyisile T. Nkomo, Sorin V. Pislaru, Hector R. Villarraga, Patricia A. Pellikka, Daniel J. Crusan, Jae K. Oh

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Left ventricular global longitudinal strain (GLS) is associated with long-term outcomes of patients with severe aortic stenosis. However, its prognostic value in patients with moderate aortic stenosis remains unknown. Methods: Patients diagnosed with moderate aortic stenosis (1.0< aortic valve area ≤1.5 cm2) and left ventricular ejection fraction ≥50% were identified. GLS was assessed by 2-dimensional strain imaging using speckle-tracking method. All-cause mortality was assessed according to the median GLS value. Results: Two hundred eighty-seven patients were included (median age 76 years; 47% male). Mean aortic valve area was 1.25 cm2, left ventricular ejection fraction 62%, and median GLS -15.2%. During a median follow-up of 3.9 years, there were 103 deaths (36%). Mortality was higher in patients with GLS>-15.2% (hazard ratio 2.62 [95% CI 1.69-4.06]) compared with patients with GLS ≤-15.2% even after adjusting for confounders. Mortality rates at 1, 3, 5 years were 21%, 35%, 48%, respectively, in patients with GLS >-15.2%, and 6%, 15%, 19% in those with GLS ≤-15.2%. Even among those with left ventricular ejection fraction ≥60%, GLS discriminated higher-risk patients (P=0.0003). During follow-up, 106 (37%) patients underwent aortic valve replacement with median waiting-time of 2.4 years, and their survival was better than patients without aortic valve replacement. Among those patients undergoing aortic valve replacement, prognosis was still worse in patients with GLS >-15.2% (P=0.04). Mortality rates at 1, 3, 5 years were 2%, 10%, 20%, respectively, in patients with GLS >-15.2% and 2%, 5%, 6% in those with GLS ≤-15.2%. Conclusions: Impaired GLS in moderate aortic stenosis patients is associated with higher mortality rates even among those undergoing aortic valve replacement.

Original languageEnglish (US)
Article numbere009958
JournalCirculation: Cardiovascular Imaging
StateAccepted/In press - 2020


  • aortic valve
  • echocardiography
  • prognosis
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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