{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:51:10Z","timestamp":1792788670982,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study evaluates whether multi-chamber myocardial deformation analysis using speckle tracking echocardiography (STE) can enhance validated current staging systems and improve risk stratification for patients with moderate-to-severe aortic stenosis (AS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We reanalysed 2D, Doppler, and STE data obtained from two cohorts: derivation (654 patients, median age: 82 years; 51% men) and validation (237 patients, median age: 77 years; 55% men) with at least moderate AS (aortic valve area &amp;lt; 1.5\u2005cm2). The receiver operator characteristic curve analysis identified optimal cut-off values linked to outcomes: 15% for left ventricular global longitudinal strain (LVGLS), 13% for peak atrial longitudinal strain (PALS), and 19% for right ventricular free-wall strain (RVFWS). Patients have been divided into five stages: Stage 0, no left-side damage (LVGLS \u2265 15% and PALS \u2265 13%); Stage 1, partial left-side damage (LVGLS &amp;lt; 15% or PALS &amp;lt; 13%); Stage 2, definite left-side damage (LVGLS &amp;lt; 15% and PALS &amp;lt; 13%); Stage 3, no right-side damage (RVFWS \u2265 19%); and Stage 4, right-side damage (RVFWS &amp;lt; 19%). In a multivariable Cox regression analysis, the new staging scheme remained independently associated with an increased risk of all-cause death [adjusted-hazard ratio: 1.28; 95% confidence interval (CI): 1.10\u20131.48; P = 0.001]. This new staging classification exhibited higher predictive power [area under the curve (AUC) 0.67; 95% CI 0.62\u20130.73] than those proposed by G\u00e9n\u00e9reux et al. (Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J 2017;38:3351\u20138.) (AUC 0.62; 95% CI 0.56\u20130.67; P = 0.002) and Tastet et al. (Staging cardiac damage in patients with asymptomatic aortic valve stenosis. J Am Coll Cardiol 2019;74:550\u201363.) (AUC 0.64; 95% CI 0.58\u20130.70; P = 0.041) for 2-year all-cause death, with similar findings in the validation cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our staging system for detecting cardiac damage, incorporating multi-chamber myocardial deformation, exhibits a stronger association with outcomes than previously validated systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf035","type":"journal-article","created":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T23:17:58Z","timestamp":1737847078000},"page":"908-917","source":"Crossref","is-referenced-by-count":22,"title":["A novel staging system of cardiac damage in aortic stenosis based on multi-chamber myocardial deformation"],"prefix":"10.1093","volume":"26","author":[{"given":"Michele","family":"Tomaselli","sequence":"first","affiliation":[{"name":"Department of Cardiology, Istituto Auxologico Italiano, IRCCS , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1103-2203","authenticated-orcid":false,"given":"Paolo","family":"Springhetti","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University of Verona , Piazzale Aristide Stefani 1, 37100 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5660-6162","authenticated-orcid":false,"given":"Giovanni","family":"Benfari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University of Verona , Piazzale Aristide Stefani 1, 37100 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Penso","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istituto Auxologico Italiano, IRCCS , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Clement","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u2018Grigore T. Popa\u2019, University of Medicine and Pharmacy , Iasi ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Pilan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University of Verona , Piazzale Aristide Stefani 1, 37100 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University of Verona , Piazzale Aristide Stefani 1, 37100 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Ciceri","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University of Verona , Piazzale Aristide Stefani 1, 37100 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Buta","sequence":"additional","affiliation":[{"name":"Cardiology Department, University of Medicine and Pharmacy \u2018Carol Davila\u2019, Emergency Institute for Cardiovascular Diseases \u2018Prof. Dr. C. C. Iliescu\u2019 , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Scarsini","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University of Verona , Piazzale Aristide Stefani 1, 37100 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Calin","sequence":"additional","affiliation":[{"name":"Cardiology Department, University of Medicine and Pharmacy \u2018Carol Davila\u2019, Emergency Institute for Cardiovascular Diseases \u2018Prof. Dr. C. C. Iliescu\u2019 , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Nitu","sequence":"additional","affiliation":[{"name":"Cardiology Department, University of Medicine and Pharmacy \u2018Carol Davila\u2019, Emergency Institute for Cardiovascular Diseases \u2018Prof. Dr. C. C. Iliescu\u2019 , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noela","family":"Radu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istituto Auxologico Italiano, IRCCS , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2514-3668","authenticated-orcid":false,"given":"Denisa","family":"Muraru","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istituto Auxologico Italiano, IRCCS , Milan ,","place":["Italy"]},{"name":"Department of Medicine and Surgery, University of Milano-Bicocca , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan A","family":"Popescu","sequence":"additional","affiliation":[{"name":"Cardiology Department, University of Medicine and Pharmacy \u2018Carol Davila\u2019, Emergency Institute for Cardiovascular Diseases \u2018Prof. Dr. C. C. 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