title: Relation of global longitudinal strain to left ventricular geometry in aortic valve stenosis.
abstract: BACKGROUND
  In patients with aortic stenosis (AS), increased afterload induces changes in left ventricular (LV) geometry to preserve a normal ejection fraction (EF). Nevertheless, myocardial dysfunction may occur in spite of a normal EF. Global longitudinal strain (GLS) analysis can detect subtle contractile dysfunction at a pre-clinical stage. The aim of our study was to assess LV function deteriorations with GLS analysis and the association with geometric changes in patients with AS and normal EF.
  
  
  METHODS
  Forty four patients with moderate to severe AS and 40 controls were enrolled. All patients underwent echocardiography, including two-dimensional strain imaging. The relative wall thickness and LV muscle mass measurements were performed with magnetic resonance imaging and patients were subdivided into four groups: Group 1 with normal LV, Group 2 with concentric remodeling, Group 3 with eccentric hypertrophy, and Group 4 with concentric hypertrophy.
  
  
  RESULTS
  The total group of patients with AS showed a GLS of -15.3 ± 3.6% while the control group reached -18.9 ± 3.2% (p < 0.001). GLS was lower in the hypertrophy Groups 3 and 4 compared to Groups 1 and 2 (12.9 ± 3.4% vs 17.2 ± 2.5%, p < 0.05, respectively). Splitting the patients into Groups 1 to 4, the GLS was -17.2 ± 2.4%, -17.2 ± 2.7%, -12.4 ± 3.8% and -13.1 ± 3.3, respectively (p = 0.002).
  
  
  CONCLUSIONS
  In subjects with AS, lower GLS is related to LV hypertrophy, but not to the presence of concentric remodeling. Assessment of GLS can identify subtle contractile dysfunction independent of a preserved EF, and might be useful in identifying patients at high risk for the transition from compensatory to pathological remodeling. (Cardiol J 2011; 18, 2: 151-156).
authors: Institute for Heart and Circulation Research, University Witten/Herdecke, Germany. wilfried.dinh@helios-kliniken.de
authors: Wilfried
authors: W
authors: Dinh
authors: Werner
authors: W
authors: Nickl
authors: Jan
authors: J
authors: Smettan
authors: Till
authors: T
authors: Koehler
authors: Lars
authors: L
authors: Bansemir
authors: Mark
authors: M
authors: Lankisch
authors: Thomas
authors: T
authors: Scheffold
authors: Michael Coll
authors: MC
authors: Barroso
authors: Jan-Erik
authors: JE
authors: Gülker
authors: Reiner
authors: R
authors: Füth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D057791:Cardiac Imaging Techniques / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology; D020257:Ventricular Remodeling