Early myocardial abnormalities in asymptomatic patients with severe isolated congenital aortic regurgitation: an ultrasound tissue characterization and strain rate study.
BACKGROUND
Aortic valve regurgitation (AR) in the pediatric population has increased in recent years because of the expanded use of new surgical and hemodynamic procedures. Unlike adult patients, few predictors for the need of operation have been proposed in young asymptomatic or mildly symptomatic patients with AR.


METHODS
To unmask early abnormalities of left ventricular (LV) function, 59 participants were enrolled: 14 asymptomatic patients (mean age 18 years) with congenital isolated severe AR and normal LV function (LV ejection fraction > 50%); and 45 healthy control subjects with comparable age and body surface area. All the studied population underwent standard echocardiographic examination, integrated backscatter, and strain rate imaging study.


RESULTS
Conventional echocardiographic indices of global LV systolic performance for patients with AR were similar to that of control subjects. Compared with control subjects, integrated backscatter analysis demonstrated a significant reduction in cyclic variation in both septal and posterior walls ( P < .05). LV radial and longitudinal deformation properties for patients with AR were significantly reduced ( P < .05) as assessed by peak systolic strain rate.


CONCLUSIONS
Our results demonstrated the ability of integrated backscatter and strain rate imaging to detect early subclinical abnormalities in young patients with severe congenital AR despite the presence of a normal ejection fraction.
Di Salvo
Giovanni
G
Physiopathology of the Cardio-Respiratory System and Associated Biotechnologies, Second University of Naples, Monaldi Hospital, Via Omodeo 45, Naples 80128, Italy. giodisal@yahoo.it
Pacileo
Giuseppe
G
Verrengia
Marina
M
Rea
Alessandra
A
Limongelli
Giuseppe
G
Caso
Pio
P
Russo
Maria Giovanna
MG
Calabrò
Raffaele
R
D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000151:congenital* / Q000000981:diagnostic imaging*; D009202:Cardiomyopathies / Q000151:congenital* / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D012720:Severity of Illness Index; D013599:Systole; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D016277:Ventricular Function, Left