Background—: Current guidelines recommend intervention for symptomatic aortic stenosis, but the management of asymptomatic aortic stenosis remains controversial. As left ventricular global longitudinal strain (GLS) has been shown to predict cardiovascular outcome, we sought to find whether its use could guide the assessment of risk in these patients. Methods and Results—: We prospectively followed 79 patients with severe asymptomatic aortic stenosis (39 men; mean age, 77 ± 12 years; aortic valve [AV] area index, 0.36 cm ² /m ² ). In addition to standard echocardiography, speckle strain was measured to assess GLS. Patients were followed for cardiac death and AV replacement driven by symptom development. A multivariable Cox regression was performed to identify associations with events. During 23 ± 20 months, 3 patients had cardiac death and 49 underwent AV replacement. Event-free survival was 72 ± 5% at 1 year, 50 ± 5% at 2 years, and 24 ± 5% at 4 years. Death and AV replacement were predicted by GLS (hazard ratio [HR], 1.14 [95% CI, 1.01–1.28]; P =0.037), as well as extent of AV calcification (HR, 2.44 [95% CI, 1.17–5.12]; P =0.018), peak transaortic pressure gradient (HR, 1.03 [95% CI, 1.01–1.04]; P <0.001), valvulo-arterial impedance (HR, 1.32 [95% CI, 1.04–1.67]; P =0.045), and Society of Thoracic Surgeons Predicted Risk of Morbidity and Mortality (HR, 0.95 [95% CI, 0.90–1.00]; P =0.052). A mean absolute GLS <15% was associated with a significant excess mortality, and this measurement added incremental prognostic value to the Society of Thoracic Surgeons Predicted Risk of Morbidity and Mortality, transaortic peak pressure gradient, AV calcification, and valvulo-arterial impedance. Conclusions—: GLS is associated with outcomes in patients with severe asymptomatic aortic stenosis, incremental to other clinical and echocardiographic variables.

Objectives The traditional risk score (RAMA-EGAT) has been shown to be an accurate scoring system for predicting coronary artery disease (CAD). Arterial stiffness measured by the cardio–ankle vascular index (CAVI) is known to be a marker of atherosclerotic burden. A study was undertaken to determine whether CAVI improves the prediction of CAD beyond the RAMA-EGAT score. Design Cross-sectional study. Patients Patients with a moderate to high risk for CAD by the RAMA-EGAT score were enrolled between November 2005 and March 2006. 64-slice multidetector CT coronary angiography was used to evaluate the coronary artery calcium score and coronary stenosis. Arterial stiffness was assessed by CAVI. Results 1391 patients of median age 59 years (range 31–88) were enrolled in the study, 635 (45.7%) men and 756 (54.3%) women. Of the 1391 patients, 346 (24.87%) had coronary stenosis. There was a correlation between CAVI and the prevalence of coronary stenosis after adjusting for traditional CAD risk factors (OR 3.29). In addition, adding CAVI into the RAMA-EGAT score (modified RAMA-EGAT score) improved the prediction of CAD incidence, increasing C-statistics from 0.72 to 0.85 and resulting in a net reclassification improvement of 27.7% (p<0.0001). Conclusion CAVI is an independent risk predictor for CAD. The addition of CAVI to the RAMA-EGAT score significantly improves the diagnostic yield of CAD.

Background: The aim of this study was to compare left ventricular ( LV ) remodeling using myocardial strain between patients with severe aortic stenosis ( AS ) treated with transcatheter aortic valve replacement ( TAVR ) with and without prosthesis‐patient mismatch ( PPM ). Methods and Results: In a retrospective study, speckle‐tracking echocardiography was used to measure global longitudinal strain ( GLS ) and strain rate ( GLSR ), circumferential strain, and rotation before and at mid‐term follow‐up post‐ TAVR . Moderate and severe PPM were defined as an effective orifice area ≤0.85 and <0.65 cm ² /m ² , respectively. A total of 102 patients (median age, 83 years [77–88]) with severe AS were included. At 6±3 months post‐ TAVR , moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m ² ; P =0.001) at follow‐up whereas those with PPM did not. There was a significant improvement in LV GLS (−12.8±4.0 to −14.3±4.3%; P =0.01), GLSR (−0.61±0.20 to −0.73±0.25 second ⁻¹ ; P <0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second ⁻¹ ; P <0.001) in patients without PPM , but not in those with PPM . After adjustment for pre‐ TAVR ejection fraction and post‐ TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM . After a median follow‐up of 46.1 months (interquartile range, 35.4–60.8), there was no difference in survival between patients with and without PPM . Conclusions: TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM . Presence of PPM was not associated with mortality.