Relationship between severity of symptoms and markers of myocardial damage in patients with severe aortic stenosis referred to cardiac surgery

Purpose: Aortic stenosis (AS) has a long asymptomatic period, but when the symptoms do occur there is a rapid progression of the disease with an elevated morbimortality. We aimed to describe the clinical characteristics and to identify predictors of immediate postoperative outcomes in a group of patients referred for aortic valve replacement (AVR). Methods: A comprehensive echocardiogram was prospectively performed on 99 consecutive patients (71±9years; 55 men) with severe AS (valve area index 0.36±0.09cm2/m2) referred for AVR to a tertiary center. The New York Heart Association functional class (NYHA), the left ventricular (LV) ejection fraction (EF), the global longitudinal peak systolic strain (GLPS), the pro-B-type natriuretic peptide (BNP) and the high sensitive Troponin (hs-TNT) were all determined at the time of admission. Results: Patients were divided in two groups: 68 in Group A (asymptomatic [9 of 68] or with NYHA I/II), and 31 in Group B (NYHA III/IV). Patients in Group B were older (74±9 vs. 70±9; p 0.04) and more likely to have hypertension (97% vs. 79%; p 0.03), renal failure (42% vs. 12%; p 0.001) and atrial fibrillation (22.6% vs. 3%; p 0.004). There were no differences between the two groups with the echocardiographic severity of the AS or the preoperative risk scores. Group B had higher BNP (median, 443ng/L [interquartile range, 239-1233] vs. 1512ng/L [593-6504]; p 500ng/L. There was a significant linear relationship between GLPS and BNP (r = 0.537, p<0.001) and hs-TNT (r = 0.410, p<0.001). In addition, GLPS was an independent predictor for postoperative composite outcome (death, myocardial infarction, stroke, shock and reoperation). Conclusions: The severity of symptoms was associated with the grade of myocardial damage, as assessed by echocardiography and biomarkers, in patients with severe AS referred for AVR. GLPS appears to be more sensitive in detecting early myocardial damage compared with conventional EF and is an independent predictor of postoperative outcomes and may be helpful for risk stratification.