title: Subclinical left ventricular dysfunction in asymptomatic severe aortic regurgitation patients with normal ejection fraction: a combined tissue Doppler and velocity vector imaging study.
abstract: OBJECTIVE
  Our aim was to evaluate subclinical left ventricular (LV) dysfunction, by two novel echocardiographic techniques, velocity vector imaging (VVI)-derived strain imaging and tissue Doppler imaging (TDI), in patients with asymptomatic, severe aortic regurgitation (AR).
  
  
  METHODS
  Forty patients with severe AR with normal ejection fraction and 30 controls were included to the study. All patients underwent a standard echocardiography extended with TDI and VVI analyses. To evaluate the LV longitudinal and circumferential deformation, segmental systolic peak strain and strain rate (SRs) data were acquired from parasternal short axis, apical four-chamber, two-chamber, and long axis views, and additionally LV myocardial velocities, isovolumic myocardial acceleration (IVA), peak systolic velocity (Sa) and peak myocardial velocity during isovolumic contraction (IVV) assessed by TDI.
  
  
  RESULTS
  IVA was the only TDI-derived parameter which was significantly impaired in AR patients (P = 0.0001). Both longitudinal and circumferential strain and SRs of the LV were significantly decreased in patients with severe AR (P = 0.0001). Longitudinal and circumferential strain/SRs and TDI-derived LV IVA were inversely correlated with LV end-diastolic diameter (P = 0.0001) and end-systolic diameter (P = 0.0001). TDI-derived IVA was also very well correlated with longitudinal deformation parameters (P = 0.0001).
  
  
  CONCLUSIONS
  VVI- derived strain imaging and TDI-derived IVA may be used as adjunctive, reliable, noninvasive parameters for evaluating subclinical ventricular dysfunction in patients with chronic, severe AR. This may help to identify patients for closer follow-up and to determine the need for surgery before developing irreversible, severe heart failure.
authors.affiliation: Cardiology Division, Florence Nightingale Hospital, Postal code: 34381, Caglayan, Istanbul, Turkey.
authors.forename: Yelda
authors.initials: Y
authors.lastname: Tayyareci
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yildirimturk
authors.forename: Vedat
authors.initials: V
authors.lastname: Aytekin
authors.forename: I C Cemsid
authors.initials: IC
authors.lastname: Demiroglu
authors.forename: Saide
authors.initials: S
authors.lastname: Aytekin
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*