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Table 2 Independent predictors of adverse events in patients with aortic stenosis - results of studies assessing modern echocardiographic parameters

From: The left ventricle in aortic stenosis – imaging assessment and clinical implications

Independent predictors Cut-off values Population Adverse events Follow-up Reference
- Basal longitudinal strain (STE) −13% - 65 asymptomatic pts with AS, AVA < 1 cm2, LVEF >55% Combined end-point: re-hospitalization for any cardiac cause, aortic valve surgery, cardiovascular death within 12 months 12 months Lafitte et al. [5]
- Systolic annular velocity (TDI)   - 126 asymptomatic pts with AVA ≤ 1,2 cm2, LVEF >55% Combined end point: onset of symptoms; cardiac-related death; need for AVR 20.3 ± 17.8 months (median follow-up period) Lancellotti et al. [64]
- Late diastolic annular velocity (TDI)
- E/e' ratio
- Indexed LA area
- BNP
- LV longitudinal deformation (STE) - 15.9% - 163 asymptomatic pts with AVAi < 0.06 cm2/m2; LVEF >55% Combined end-point: cardiac death; development of significant symptoms; clinical need of AVR 20 ± 19 months Lancellotti et al. [65]
- Peak aortic jet velocity 4.4 m/s
- Valvuloarterial impedance 4.9 mmHg/ml/m2
12.2 cm2/m2
- Indexed LA area    
- Global LV longitudinal strain (STE) −15% - 79 asymptomatic patients with severe AS (AVA <1 cm2 or transaortic jet velocity >4 m/s) and LVEF ≥ 50% Combined end-point: cardiac death; AVR driven by symptom development 23 ± 20 months Yingchoncharoen et al. [66]
- STS-PRMM  
- Aortic valve calcification score
- AVA  
- Valvuloarterial impedance
- E/e’ ratio (lateral annular site) 15 - 125 symptomatic and asymptomatic unoperated patients with severe AS All cause death 1 year Biner et al. [67]
- BNP 300 ng/ml
- Global LV longitudinal strain (STE) −15% (−12.8%*) - 146 symptomatic and asymptomatic pts with mild, moderate and severe AS All-cause mortality median follow-up of 2.1 years Kearney et al. [68]
- Age-adjusted Charlson comorbidity
Index
- Symptom severity class
- Systolic peak radial strain rate (TDI) 2/s - 32 symptomatic patients with AVR for severe AS (AVA < 1 cm2, LVEF 61 ± 10% ) Combined end-point: cardiovascular death, worsening of HF and limited exercise capacity 12 months Bauer et al. [69]
- e'
- E/Vp
- Global LV longitudinal strain (STE)**   - 125 symptomatic pts with severe AS and LVEF >40% undergoing AVR Combined end point: cardiovascular mortality and cardiac hospitalization due to worsening of HF mean follow-up of 3.8 ± 1.5 years Dahl et al.[70]
  1. TDI, Tissue Doppler imaging; STE, speckle tracking echocardiography; AVA, aortic valve area; AVAi, indexed aortic valve area; LVEF, left ventricular ejection fraction; LA, left atrium; STS-PRMM, Society of Thoracic Surgeons Predicted Risk of Morbidity and Mortality; E, early diastolic transmitral velocity; e’, mitral annulus early diastolic velocity, Vp, velocity of flow propagation into the left ventricle.
  2. *, this threshold provided the best combination of sensitivity (83%) and specificity (87%) for all-cause mortality.
  3. **, patients were divided into 4 groups according to GLS quartiles.