The value of TMAD in the prognosis of patients with asymptomatic severe aortic stenosis

REN Yongfeng; LU Jing; LI Nana; WANG Xiaojun; LI Qi

Abstract：Objective To investigate the value of tissue tracking mitral annular displacement(TMAD)in evaluating left ven-tricular longitudinal motor function and prognosis in patients with preserved ejection fraction asymptomatic severe aortic stenosis(SAS).Methods Sixty asymptomatic SAS patients with preserved ejection fraction(LVEF≥50%)were selected and divided into two groups,i.e.,group A and B,based on the follow-up results and the occurrence of cardiovascular related time.All se-lected patients were asymptomatic patients with preserved ejection fraction(LVEF≥50%)at the initial examination,and were followed up for 24 months.The dynamic images of apical four chamber,three chamber and two chamber sections were collected for 4 consecutive cardiac cycles,and the left ventricular ejection fraction(LVEF)was measured by biplane Simpson method.The left ventricular global longitudinal strain(LVGLS)was obtained by two-dimensional speckle tracking echocardiography,and the longitudinal mean displacement of the midpoint between the septum and the lateral valve ring was obtained by four cham-ber heart(TMAD).The equipment can automatically obtain the percentage of TMAD in the end diastolic left ventricular length diameter(TMAD Midpt).The differences of the above parameters between group A and group B were compared,and the value of TMAD Midpt in predicting cardiac related events in SAS patients was analyzed.Results Among the 60 patients,there were 21 cases in group A,accounting for 35.0%,and 39 cases in group B,accounting for 65.0%.TMAD Midpt and lvgls in group A were significantly lower than those in group B(P<0.01),and there was no significant difference in LVEF between the two groups(P>0.05).The myocardial mass index(MI)and B-type brain natriuretic peptide(BNP)in group A were significantly higher than those in group B(P<0.01),but there was no significant difference in other clinical data and echocardiographic parameters(P>0.05).TMAD Midpt decreased with the decrease of LVGLS in 60 patients,and there was a significant positive correlation be-tween them(r = 0.696,P<0.01).According to ROC curve analysis,TMAD Midpt had considerable value in predicting cardiac events and LNGLS.The areas under the curve were 0.897 and 0.901 respectively(P<0.01).Conclusion TMAD technology can simply and quickly evaluate the left ventricular function impairment in asymptomatic SAS patients with preserved left ven-tricular ejection fraction.It is of great value to evaluate the prognosis of these patients and is worthy of clinical application.