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Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis

Adverse ventricular remodeling is an inflexion point of disease progression in aortic stenosis (AS) and a major determinant of prognosis. Intervention before irreversible myocardial damage is of paramount importance to sustain favorable post-operative outcomes. Current guidelines recommend a left ve...

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Autores principales: Anastasiou, Vasileios, Daios, Stylianos, Bazmpani, Maria-Anna, Moysidis, Dimitrios V., Zegkos, Thomas, Karamitsos, Theodoros, Ziakas, Antonios, Kamperidis, Vasileios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10217605/
https://www.ncbi.nlm.nih.gov/pubmed/37238238
http://dx.doi.org/10.3390/diagnostics13101756
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author Anastasiou, Vasileios
Daios, Stylianos
Bazmpani, Maria-Anna
Moysidis, Dimitrios V.
Zegkos, Thomas
Karamitsos, Theodoros
Ziakas, Antonios
Kamperidis, Vasileios
author_facet Anastasiou, Vasileios
Daios, Stylianos
Bazmpani, Maria-Anna
Moysidis, Dimitrios V.
Zegkos, Thomas
Karamitsos, Theodoros
Ziakas, Antonios
Kamperidis, Vasileios
author_sort Anastasiou, Vasileios
collection PubMed
description Adverse ventricular remodeling is an inflexion point of disease progression in aortic stenosis (AS) and a major determinant of prognosis. Intervention before irreversible myocardial damage is of paramount importance to sustain favorable post-operative outcomes. Current guidelines recommend a left ventricular ejection fraction (LVEF)-based strategy to determine the threshold for intervention in AS. However, LVEF has several pitfalls: it denotes the left ventricular cavity volumetric changes and it is not suited to detecting subtle signs of myocardial damage. Strain has emerged as a contemporary imaging biomarker that describes intramyocardial contractile force, providing information on subclinical myocardial dysfunction due to fibrosis. A large body of evidence advocates its use to determine the switch from adaptive to maladaptive myocardial changes in AS, and to refine thresholds for intervention. Although mainly studied in echocardiography, studies exploring the role of strain in multi-detector row computed tomography and cardiac magnetic resonance are emerging. This review, therefore, summarizes contemporary evidence on the role of LVEF and strain imaging in AS prognosis, aiming to move from an LVEF-based to a strain-based approach for risk stratification and therapeutic decision-making in AS.
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spelling pubmed-102176052023-05-27 Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis Anastasiou, Vasileios Daios, Stylianos Bazmpani, Maria-Anna Moysidis, Dimitrios V. Zegkos, Thomas Karamitsos, Theodoros Ziakas, Antonios Kamperidis, Vasileios Diagnostics (Basel) Review Adverse ventricular remodeling is an inflexion point of disease progression in aortic stenosis (AS) and a major determinant of prognosis. Intervention before irreversible myocardial damage is of paramount importance to sustain favorable post-operative outcomes. Current guidelines recommend a left ventricular ejection fraction (LVEF)-based strategy to determine the threshold for intervention in AS. However, LVEF has several pitfalls: it denotes the left ventricular cavity volumetric changes and it is not suited to detecting subtle signs of myocardial damage. Strain has emerged as a contemporary imaging biomarker that describes intramyocardial contractile force, providing information on subclinical myocardial dysfunction due to fibrosis. A large body of evidence advocates its use to determine the switch from adaptive to maladaptive myocardial changes in AS, and to refine thresholds for intervention. Although mainly studied in echocardiography, studies exploring the role of strain in multi-detector row computed tomography and cardiac magnetic resonance are emerging. This review, therefore, summarizes contemporary evidence on the role of LVEF and strain imaging in AS prognosis, aiming to move from an LVEF-based to a strain-based approach for risk stratification and therapeutic decision-making in AS. MDPI 2023-05-16 /pmc/articles/PMC10217605/ /pubmed/37238238 http://dx.doi.org/10.3390/diagnostics13101756 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Anastasiou, Vasileios
Daios, Stylianos
Bazmpani, Maria-Anna
Moysidis, Dimitrios V.
Zegkos, Thomas
Karamitsos, Theodoros
Ziakas, Antonios
Kamperidis, Vasileios
Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis
title Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis
title_full Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis
title_fullStr Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis
title_full_unstemmed Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis
title_short Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis
title_sort shifting from left ventricular ejection fraction to strain imaging in aortic stenosis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10217605/
https://www.ncbi.nlm.nih.gov/pubmed/37238238
http://dx.doi.org/10.3390/diagnostics13101756
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