Predictive value of left ventricular global function index in patients with aortic stenosis

A number of factors has an impact on the survival prognosis in aortic stenosis patients. One of these factors is a left ventricular (LV) systolic function. Left ventricular global function index (LVGFI) takes into account the components of LV remodeling: LV volume, LV stroke volume, and LV myocardial volume.

Objective: to evaluate the prognostic value of LVGFI in patients with various aortic stenosis severity using echocardiography.

Material and methods. The study based on the data of previous prospective observational study from 2010–2016, followed by retrospective calculation and analysis of the LVGFI obtained by echocardiography. A total of 377 patients were included to the study, the average age was 79 (75–84) years; 128 (34%) of them were male; 70 patients (19%) had mild aortic stenosis, 116 patients (31%) moderate aortic stenosis, and 191 patients (50%) severe aortic stenosis. LVGFI was calculated as the percentage ratio of LV stroke volume to LV global volume, where LV global volume was defined as the sum of the LV mean cavity volume [(LV end-diastolic volume + LV end-systolic volume)/2] and the myocardium volume. LV myocardial volume was calculated as the ratio of LV myocardial mass to LV density (defined as 1.05 g/mL). The average follow-up period at the moment of analysis was 602.7 ± 48.72 days. All cases of death during the period of follow up were captured.

Results. The significant differences of LVGFI obtained between surviving and deceased patients (15.39% (11.35–20.95%) and 20.12% (15.16–25.98%), respectively, p < 0.001). Values of LVGFI < 18% significantly associated with the risk of death from all causes during two years of follow-up in both mild aortic stenosis and moderate and severe aortic stenosis.

Conclusion. Thus, in patients with aortic stenosis in the group of fatal outcomes the values of the LVGFI were significantly lower than in the group of surviving patients. LVGFI values of less than 18% associated with the risk of death from all causes in any grade of aortic stenosis. LVGFI can be used for mortality risk stratification in patients with aortic stenosis.

1. Lee G, Chikwe J, Milojevic M, Wijeysundera HC, Biondi-Zoccai G, Flather M, Gaudino MFL, Fremes SE, Tam DY. ESC/EACTS vs. ACC/AHA guidelines for the management of severe aortic stenosis. Eur Heart J. 2023 Mar 7;44(10):796-812. doi: 10.1093/eurheartj/ehac803. PMID: 36632841.

2. Singh GK, van der Bijl P, Goedemans L, Vollema EM, Abou R, Ajmone Marsan N, Bax JJ, Delgado V. Prevalence of Aortic Valve Stenosis in Patients With ST-Segment Elevation Myocardial Infarction and Effect on Long-Term Outcome. Am J Cardiol. 2021 Aug 15;153:30-35. doi: 10.1016/j.amjcard.2021.05.012. Epub 2021 Jun 22. PMID: 34167785.

3. Patel KP, Chahal A, Mullen MJ, Rathod K, Baumbach A, Lloyd G, Treibel TA, Awad WI, Ricci F, Khanji MY. Acute Decompensated Aortic Stenosis: State of the Art Review. Curr Probl Cardiol. 2023 Jan;48(1):101422. doi: 10.1016/j.cpcardiol.2022.101422. Epub 2022 Sep 24. PMID: 36167225.

4. Wal P, Rathore S, Aziz N, Singh YK, Gupta A. Aortic stenosis: a review on acquired pathogenesis and ominous combination with diabetes mellitus. Egypt Heart J. 2023 Apr 7;75(1):26. doi: 10.1186/s43044-023-00345-6. PMID: 37027109; PMCID: PMC10082141.

5. Yeo KK, Low RI. Aortic stenosis: assessment of the patient at risk. J Interv Cardiol. 2007 Dec;20(6):509-16. doi: 10.1111/j.1540-8183.2007.00297.x. PMID: 18042056.

6. Bohbot Y, Renard C, Manrique A, Levy F, Maréchaux S, Gerber BL, Tribouilloy C. Usefulness of Cardiac Magnetic Resonance Imaging in Aortic Stenosis. Circ Cardiovasc Imaging. 2020 May;13(5):e010356. doi: 10.1161/CIRCIMAGING.119.010356. Epub 2020 May 6. PMID: 32370617.

7. Joseph J, Naqvi SY, Giri J, Goldberg S. Aortic Stenosis: Pathophysiology, Diagnosis, and Therapy. Am J Med. 2017 Mar;130(3):253-263. doi: 10.1016/j.amjmed.2016.10.005. Epub 2016 Nov 1. PMID: 27810479.

8. Zakkar M, Bryan AJ, Angelini GD. Aortic stenosis: diagnosis and management. BMJ. 2016 Oct 19;355:i5425. doi: 10.1136/bmj.i5425. PMID: 27760734.

9. Magne J, Cosyns B, Popescu BA, Carstensen HG, Dahl J, Desai MY, Kearney L, Lancellotti P, Marwick TH, Sato K, Takeuchi M, Zito C, Casalta AC, Mohty D, Piérard L, Habib G, Donal E. Distribution and Prognostic Significance of Left Ventricular Global Longitudinal Strain in Asymptomatic Significant Aortic Stenosis: An Individual Participant Data Meta-Analysis. JACC Cardiovasc Imaging. 2019 Jan;12(1):84-92. doi: 10.1016/j.jcmg.2018.11.005. PMID: 30621997.

10. Mewton N, Opdahl A, Choi EY, Almeida AL, Kawel N, Wu CO, Burke GL, Liu S, Liu K, Bluemke DA, Lima JA. Left ventricular global function index by magnetic resonance imaging--a novel marker for assessment of cardiac performance for the prediction of cardiovascular events: the multi-ethnic study of atherosclerosis. Hypertension. 2013 Apr;61(4):770-8. doi: 10.1161/HYPERTENSIONAHA.111.198028. Epub 2013 Feb 19. PMID: 23424238; PMCID: PMC3691067.

11. Eitel I, Pöss J, Jobs A, Eitel C, de Waha S, Barkhausen J, Desch S, Thiele H. Left ventricular global function index assessed by cardiovascular magnetic resonance for the prediction of cardiovascular events in ST-elevation myocardial infarction. J Cardiovasc Magn Reson. 2015 Jul 16;17(1):62. doi: 10.1186/s12968-015-0161-x. PMID: 26174798; PMCID: PMC4502641.

12. Reinstadler SJ, Klug G, Feistritzer HJ, Kofler M, Pernter B, Göbel G, Henninger B, Müller S, Franz WM, Metzler B. Prognostic value of left ventricular global function index in patients after ST-segment elevation myocardial infarction. Eur Heart J Cardiovasc Imaging. 2016 Feb;17(2):169-76. doi: 10.1093/ehjci/jev129. Epub 2015 Jun 7. PMID: 26056134; PMCID: PMC4882876.

13. Huang S, Xu HY, Diao KY, Shi K, He Y, He S, Zhang Y, Gao Y, Shen MT, Guo YK, Yang ZG. Left ventricular global function index by magnetic resonance imaging - a novel marker for differentiating cardiac amyloidosis from hypertrophic cardiomyopathy. Sci Rep. 2020 Mar 13;10(1):4707. doi: 10.1038/s41598-020-61608-9. PMID: 32170130; PMCID: PMC7069935.

14. Desai MY, Mentias A, Alashi A, Flamm SD, Thamilarasan M, Lever HM, Popovic ZB. LV Global Function Index Provides Incremental Prognostic Value Over LGE and LV GLS in HCM. JACC Cardiovasc Imaging. 2020 Sep;13(9):2052-2054. doi: 10.1016/j.jcmg.2020.03.023. Epub 2020 Jun 17. PMID: 32563635.

15. Schober AL, Jungbauer C, Poschenrieder F, Schober AD, Hubauer U, Keyser A, Fredersdorf-Hahn S, Debl K, Maier LS, Sossalla S, Buchner S, Üçer E. Cardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention. J Clin Med. 2021 Oct 27;10(21):4980. doi: 10.3390/jcm10214980. PMID: 34768499; PMCID: PMC8584293.

16. Meloni A, Positano V, Pistoia L, Righi R, Missere M, Grassedonio E, Schicchi N, Vallone A, Gamberini MR, Cuccia L, Lisi R, Cecinati V, Spasiano A, Cademartiri F. Left ventricular global function index is associated with myocardial iron overload and heart failure in thalassemia major patients. Int J Cardiovasc Imaging. 2023 May;39(5):991-999. doi: 10.1007/s10554-023-02792-3. Epub 2023 Jan 13. PMID: 36637709.

17. Liu T, Zhou Z, Bo K, Gao Y, Wang H, Wang R, Liu W, Chang S, Liu Y, Sun Y, Firmin D, Yang G, Dong J, Xu L. Association Between Left Ventricular Global Function Index and Outcomes in Patients With Dilated Cardiomyopathy. Front Cardiovasc Med. 2021 Nov 16;8:751907. doi: 10.3389/fcvm.2021.751907. PMID: 34869657; PMCID: PMC8635067.

18. Diaz-Navarro RA, Kerkhof PLM. Left Ventricular Global Function Index and the Impact of its Companion Metric. Front Cardiovasc Med. 2021 Aug 30;8:695883. doi: 10.3389/fcvm.2021.695883. PMID: 34527709; PMCID: PMC8435684.ё

19. Krumm P, Zitzelsberger T, Weinmann M, Mangold S, Rath D, Nikolaou K, Gawaz M, Kramer U, Klumpp BD. Cardiac MRI left ventricular global function index and quantitative late gadolinium enhancement in unrecognized myocardial infarction. Eur J Radiol. 2017 Jul;92:11-16. doi: 10.1016/j.ejrad.2017.04.012. Epub 2017 Apr 17. PMID: 28624007.

20. Nwabuo CC, Moreira HT, Vasconcellos HD, Mewton N, Opdahl A, Ogunyankin KO, Ambale-Venkatesh B, Schreiner PJ, Armstrong AAC, Lewis CE, Jacobs DR, Lloyd-Jones D, Gidding SS, Lima JAC. Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults: the coronary artery risk development in young adults (CARDIA) study. Eur Heart J Cardiovasc Imaging. 2019 May 1;20(5):533-540. doi: 10.1093/ehjci/jey123. PMID: 30247530; PMCID: PMC6477648.

21. Larina V.N., Lunev V.I., Alekhin M.N. Left ventricular global function index: prognostic value in patients with heart failure aged 60 years and older. Cardiovascular Therapy and Prevention. 2020;19(5):2404. (In Russ.) doi: 10.15829/1728-8800-2020-2404

22. Kapustina A.Yu., Minushkina L.O., Alekhin M.N., Selezneva N.D., Safaryan V.I., Brazhnik V.A., Chumakova O.S., Evdokimova M.A., Galyavich A.S., Khasanov N.R., Chichkova M.A., Kosmacheva E.D., Tereshchenko S.N., Koziolova N.A., Glezer M.G., Boeva O.I., Konstantinov V.O., Zateyshchikov D.A. Left ventricular global function index as a predictor of adverse cardiovascular events in patients with acute coronary syndrome. Kardiologiia. 2021;61(8):23-31. (In Russ.) doi: 10.18087/cardio.2021.8.n1508

23. Larina V.N., Lunev V.I., Larin V.G., Golovko M.G., Sidorova V.P. Prediction of the current of heart failure in older patients with chronic kidney disease.// Therapy. 2021. (9_2021). C. 85–94. (In Russ.) doi: 10.18565/therapy.2021.9.85-94

24. Tsivanyuk M.M., Geltser B.I., Shakhgeldyan K.I., Emtseva E.D., Zavalin G.S., Shekunova O.I. Electrocardiographic, echocardiographic and lipid parameters in predicting obstructive coronary artery disease in patients with non-ST elevation acute coronary syndrome. Russian Journal of Cardiology. 2022;27(6):5036. (In Russ.) doi: 10.15829/1560-4071-2022-5036

25. Minushkina L.O., Brazhnik V.A., Selezneva N.D., Kapustina A.Y., Alekhin M.N., Zateyshchikov D.A. Left ventricular global function index and peculiarities of daily blood pressure profile in patients with arterial hypertension // Russian Medicine. - 2022. - Vol. 28. - N. 1. - P. 29-36 (In Russ.) doi: 10.17816/medjrf108905

26. Doganay B, Celebi OO. Prognostic role of the left ventricular global function index in predicting major adverse cardiovascular events in acute coronary syndrome patients. Biomark Med. 2023 Jan;17(1):5-16. doi: 10.2217/bmm-2023-0063. Epub 2023 Mar 21. PMID: 36942625.

27. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003. PMID: 25559473.

28. Lindman BR, Clavel MA, Mathieu P, Iung B, Lancellotti P, Otto CM, Pibarot P. Calcific aortic stenosis. Nat Rev Dis Primers. 2016 Mar 3;2:16006. doi: 10.1038/nrdp.2016.6. PMID: 27188578; PMCID: PMC5127286.

29. Shah SM, Shah J, Lakey SM, Garg P, Ripley DP. Pathophysiology, emerging techniques for the assessment and novel treatment of aortic stenosis. Open Heart. 2023 Mar;10(1):e002244. doi: 10.1136/openhrt-2022-002244. PMID: 36963766; PMCID: PMC10040005.

30. Coisne A, Scotti A, Latib A, Montaigne D, Ho EC, Ludwig S, Modine T, Généreux P, Bax JJ, Leon MB, Bauters C, Granada JF. Impact of Moderate Aortic Stenosis on Long-Term Clinical Outcomes: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv. 2022 Aug 22;15(16):1664-1674. doi: 10.1016/j.jcin.2022.06.022. PMID: 35981841.

31. Généreux P, Pibarot P, Redfors B, Mack MJ, Makkar RR, Jaber WA, Svensson LG, Kapadia S, Tuzcu EM, Thourani VH, Babaliaros V, Herrmann HC, Szeto WY, Cohen DJ, Lindman BR, McAndrew T, Alu MC, Douglas PS, Hahn RT, Kodali SK, Smith CR, Miller DC, Webb JG, Leon MB. Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J. 2017 Dec 1;38(45):3351-3358. doi: 10.1093/eurheartj/ehx381. PMID: 29020232; PMCID: PMC5837727.