{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:09:38Z","timestamp":1791670178848,"version":"4.3.4"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,10,4]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Global longitudinal strain (GLS) is a sensitive measure of left ventricular function and a risk marker in severe aortic stenosis. We sought to determine whether biomarkers of cardiac damage\u00a0(cardiac troponin) and stress (NT\u2010proBNP [N\u2010terminal pro\u2010B\u2010type natriuretic peptide]) could complement GLS to identify patients with severe aortic stenosis at highest risk.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              From a multicenter prospective cohort of patients with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation, we measured absolute GLS (aGLS), cardiac troponin, and NT\u2010proBNP at baseline in 499 patients. Left ventricular ejection fraction &lt;50% was observed in 19% and impaired GLS (aGLS &lt;15%) in 38%. Elevations in cardiac troponin and NT\u2010proBNP were present in 79% and 89% of those with impaired GLS, respectively, as compared with 63% and 60% of those with normal GLS, respectively (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001 for each). aGLS &lt;15% was associated with increased mortality in univariable analysis (\n              <jats:italic>P<\/jats:italic>\n              =0.009), but, in a model with both biomarkers, aGLS, and clinical covariates included, aGLS was not associated with mortality; elevation in each biomarker was associated with an increased hazard of mortality (adjusted hazard ratio, &gt;2;\n              <jats:italic>P<\/jats:italic>\n              \u22640.002 for each) when the other biomarker was elevated, but not when the other biomarker was normal (interaction\n              <jats:italic>P<\/jats:italic>\n              =0.015).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Among patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve implantation, elevations in circulating cardiac troponin and NT\u2010proBNP are more common as GLS worsens. Biomarkers of cardiac damage and stress are independently associated with mortality after transcatheter aortic valve implantation, whereas GLS is not. These findings may have implications for risk stratification of asymptomatic patients to determine optimal timing of valve replacement.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026529","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T09:42:51Z","timestamp":1664444571000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Global Longitudinal Strain and Biomarkers of Cardiac Damage and Stress as Predictors of Outcomes After Transcatheter Aortic Valve Implantation"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3342-6158","authenticated-orcid":false,"given":"Andrew S.","family":"Perry","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9958-0874","authenticated-orcid":false,"given":"Elliot J.","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3838-3994","authenticated-orcid":false,"given":"Michael","family":"Biersmith","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1799-1368","authenticated-orcid":false,"given":"William F.","family":"Fearon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology Stanford Medical Center Palo Alto CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8013-8733","authenticated-orcid":false,"given":"Sammy","family":"Elmariah","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9675-2607","authenticated-orcid":false,"given":"Juyong B.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology Stanford Medical Center Palo Alto CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8054-0642","authenticated-orcid":false,"given":"Daniel E.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville 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Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravinder R.","family":"Mallugari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-3391","authenticated-orcid":false,"given":"Samir","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology Cleveland Clinic Foundation Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4321-4538","authenticated-orcid":false,"given":"Dharam J.","family":"Kumbhani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology University of Texas Southwestern Medical Center Dallas 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