title: Myocardial deformation abnormalities in patients with aortic regurgitation: a strain rate imaging study.
abstract: OBJECTIVE
  Early left ventricular (LV) dysfunction in asymptomatic patients with severe aortic regurgitation (AR) may go undetected due to the lack of a sufficiently sensitive diagnostic tool. Ultrasonic strain/strain rate (S/SR) imaging should now provide such sensitivity in detecting early dysfunction in regional LV systolic deformation. The aim of this study was to understand and define the changes in LV regional systolic deformation based on S/SR imaging in patients with asymptomatic or minimally symptomatic AR.
  
  
  RESULTS
  Eighty-one individuals were studied: 59 asymptomatic patients with isolated non-ischaemic AR who were divided into three sub-groups such as mild, moderate, and severe AR and 22 age-matched healthy subjects. All patients underwent standard echocardiographic examinations including a tissue Doppler imaging study. For LV radial deformation, the posterior wall (LVPW) was examined. To assess LV longitudinal deformation, S and SR data were acquired from the LV lateral wall and septum. Radial as well as longitudinal peak systolic SRs were significantly decreased in patients with both moderate AR (LVPW, P=0.0009; septum, P=0.03; LV lateral wall, P=0.0009) and severe AR (P<0.0001) compared with healthy subjects. Changes in regional LV deformation correlated inversely both with LV end-diastolic volume and with end-systolic volume.
  
  
  CONCLUSIONS
  Strain rate imaging is a sensitive tool in detecting the spectrum of changes in radial and longitudinal deformation in asymptomatic or minimally symptomatic patients with AR. The index where volume was corrected by deformation should form the basis for predicting subclinical LV dysfunction in patients with increasing LV dilatation.
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Marciniak
authors.forename: George R
authors.initials: GR
authors.lastname: Sutherland
authors.forename: Maciej
authors.initials: M
authors.lastname: Marciniak
authors.forename: Piet
authors.initials: P
authors.lastname: Claus
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahangiri
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002908:Chronic Disease; D003952:Diagnostic Imaging / Q000379:methods; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*; D020257:Ventricular Remodeling / Q000502:physiology