Natural history of severe aortic stenosis: Diastolic wall strain as a novel prognostic marker

Background and Aim Diastolic wall strain ( DWS ) has been proposed as a simple noninvasive measure of left ventricular ( LV ) stiffness. This study investigated DWS as a possible predictor of mortality in severe aortic stenosis ( AS ). Methods 138 patients with severe AS (indexed aortic valve area [ AVA ]<0.6 cm 2 /m 2 ) and normal ejection fraction (>55%) were included. 52 patients (38%) had aortic valve interventions or poor image quality (n=5) and were excluded leaving 86 in the study group (84±8 years, 70% female, 69% African American). DWS was defined as ( LVPW s− LVPW d)/ LVPW s where LVPW s=left ventricular posterior wall thickness in systole and LVPW d=left ventricular wall thickness in diastole. Results Follow‐up extended 2.0±1.9 years (median 1.6 years). Mean DWS for the group was 0.21±0.11 (normal=0.4±0.07). In patients who died, DWS was significantly lower than in survivors (0.18±0.09 vs 0.24±0.11, P =.02). By contrast, traditional measures of diastolic dysfunction did not predict death. Regression analysis showed DWS predicted death even after adjusting for age, sex, race, indexed AVA , symptoms (angina, shortness of breath, dizziness, syncope), and clinical factors (creatinine, smoking, diabetes, hypertension, hyperlipidemia) ( HR 2.5 [95% CI 1.02‐5.90], P <.05). The best cutoff value for DWS of 0.25 had a sensitivity of 42% and specificity of 83% for predicting death. Conclusions DWS is an independent predictor of all‐cause mortality in patients with severe AS , even after accounting for traditional clinical and echocardiographic parameters.