Abstract 16043: Impact of Left Ventricular Global Longitudinal Strain on the Outcomes of Patients With Moderate Aortic Stenosis and Moderate Aortic Insufficiency

Background: Reduced left ventricular global longitudinal strain (GLS) is associated with worse outcomes in patients with severe aortic stenosis (AS). Its role in predicting outcomes in moderate AS is now being reported. We aim to investigate the prognostic value of GLS in patients with moderate AS and moderate aortic insufficiency (AI).

Methods: We conducted a retrospective review of 1576 patients with a diagnosis of AS and AI at a community cardiology practice. We reviewed the echocardiographic data and included 254 patients with moderate AS and moderate AI. They were retrospectively followed for 1 year from the time they initially had the echocardiography findings to note the occurrence of shortness of breath (SOB), heart failure (HF) hospitalization, or mortality during the 1 year period.

Results: Out of the 254 patients that were studied, 121 patients (47.64%) had GLS ≤16%. Demographics and comorbidities such as age, sex, hypertension, diabetes mellitus (DM), obesity, and atrial fibrillation were balanced in both arms. Patients with GLS ≤16% had significantly higher SOB (50.41% vs. 32.33%, p=0.003) and HF hospitalization (17.36% vs. 9.02%, p=0.049) during 1-year follow-up. 1-year mortality was higher in GLS ≤16% arm but not statistically significant (5.79% vs. 1.5%, p=0.065). After adjusting for patient characteristics using logistic regression, GLS ≤16% was independently associated with higher odds of SOB (aOR 2.139, 95CI 1.28-3.59, p=0.004) but not for HF hospitalization (aOR 2.022, 95CI 0.94-4.35, p=0.072) and 1-year mortality (aOR 4.165, 95CI 0.78-22.12, p=0.094).

Conclusions: GLS ≤16% is associated with an increased likelihood of SOB in patients with moderate AS and moderate AI. HF hospitalization and 1-year mortality were not statistically significant, but there is a clear trend towards worse outcomes in patients with GLS ≤16%. If future studies reproduce similar results and outcomes, it may be time to rethink the timing of aortic valve intervention.