Incremental value of myocardial work in predicting beneficial response to aortic valve replacement in patients with aortic stenosis

The predictors of favorable clinical response to aortic valve replacement (AVR) in aortic stenosis (AS) are still insufficiently defined. The increased LV afterload in AS affects the interpretation of the majority of LV systolic indices, which are load-dependent. The estimation of myocardial work (MW) is a newly developed approach, which, allowing correction of global longitudinal strain (GLS) for LV afterload, gives a more adequate insight into the intrinsic LV contractility.

To investigate whether the assessment of MW can improve the prediction of clinical and neurohormonal improvement post AVR in patients with AS.

We evaluated 126 patients (75±9 years) with severe AS who underwent transcatheter AVR (n=100) or surgical AVR (n=26). Transthoracic echocardiography, blood sampling and 6 min walk test (6MWT) were performed pre and 3 months post AVR. The following indices of MW were assessed: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE).

Post-AVR changes in the clinical and echocardiographic profile are presented in Table. Post-treatment increase in 6MWT distance was noted in 95 patients, and decrease in NT-proBNP in 94 patients. In multivariable analysis including clinical parameters and echocardiographic indices of cardiac function, morphology and aortic valve hemodynamic, baseline GWW was the only independent echocardiographic predictor of post-AVR improvement in 6MWT distance (beta=−0.24, SE 0.09, p=0.01), whereas baseline GWE was, in addition to tricuspid regurgitation pressure gradient (TRPG) and E/e' ratio, independently associated with the post-AVR decrease in NT-proBNP (beta=0.27, SE 0.09, p=0.004).

In patients with severe AS undergoing AVR, higher values of GWW do not favor post-treatment functional improvement as assessed by 6MWT. The beneficial neurohormonal response to AVR is more pronounced in patients with less efficient LV contraction at baseline.

Type of funding sources: None.