title: Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery.
abstract: OBJECTIVE
  The aim of this study was to test myocardial deformation imaging using speckle-tracking echocardiography for predicting outcomes in chronic aortic regurgitation.
  
  
  BACKGROUND
  In chronic aortic regurgitation, left ventricular (LV) dysfunction must be detected early to allow timely surgery. Speckle-tracking echocardiography has been proposed for this purpose, but the clinical value of this method in aortic regurgitation has not been established.
  
  
  METHODS
  A longitudinal study was performed in 64 patients with moderate to severe aortic regurgitation. Thirty-five patients were managed conservatively with frequent clinical visits and sequential echocardiography and followed for an average of 19 ± 8 months, while 29 patients underwent surgery for the valve lesion and were followed for 6 months post-operatively. Baseline LV function by speckle-tracking and conventional echocardiography was compared with impaired outcome after surgery (defined as persisting symptoms or persisting LV dilation [LV end-diastolic volume index ≥ 87 ml/m(2)] or dysfunction [LV ejection fraction <50%]) and with disease progression during conservative management (defined as development of symptoms, increase in LV volume >15%, or decrease in LV ejection fraction >10%).
  
  
  RESULTS
  Reduced myocardial systolic strain, systolic strain rate, and early diastolic strain rate by speckle-tracking echocardiography was associated with disease progression during conservative management (-16.3% vs. -19.0%, p = 0.02; -1.04 vs. -1.19 s(-1), p = 0.02; and 1.20 vs. 1.60 s(-1), p = 0.002, respectively) and with impaired outcome after surgery (-11.5% vs. -15.6%, p = 0.01; -0.88 vs. -1.01 s(-1), p = 0.04; and 0.98 vs. 1.33 s(-1), p = 0.01, respectively). Conventional parameters of LV function and size (LV ejection fraction and LV end-diastolic volume index) were associated with outcome after surgery (p = 0.04 and p = 0.01, respectively) but not with outcome during conservative management (p = 0.57 and p = 0.39, respectively).
  
  
  CONCLUSIONS
  Speckle-tracking echocardiography is useful for the early detection of LV systolic and diastolic dysfunction in chronic aortic regurgitation.
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. thueolsen@post.tele.dk
authors.forename: Niels Thue
authors.initials: NT
authors.lastname: Olsen
authors.forename: Peter
authors.initials: P
authors.lastname: Sogaard
authors.forename: Henrik B W
authors.initials: HB
authors.lastname: Larsson
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Goetze
authors.forename: Christian
authors.initials: C
authors.lastname: Jons
authors.forename: Rasmus
authors.initials: R
authors.lastname: Mogelvang
authors.forename: Olav W
authors.initials: OW
authors.lastname: Nielsen
authors.forename: Thomas
authors.initials: T
authors.lastname: Fritz-Hansen
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006348:Cardiac Surgical Procedures; D002908:Chronic Disease; D003718:Denmark; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016277:Ventricular Function, Left