title: Speckle tracking echocardiography derived 2-dimensional myocardial strain predicts left ventricular function and mass regression in aortic stenosis patients undergoing aortic valve replacement.
abstract: Regression of left ventricular (LV) mass in severe aortic stenosis (AS) following aortic valve replacement (AVR) reduces the potential risk of sudden death and congestive heart failure associated with LV hypertrophy. We investigated whether abnormalities of resting LV deformation in severe AS can predict the lack of regression of LV mass following AVR. Two-dimensional speckle tracking echocardiography (STE) was performed in a total of 100 subjects including 60 consecutive patients with severe AS having normal LV ejection fraction (EF > 50 %) and 40 controls. STE was performed preoperatively and at 4 months following AVR, including longitudinal strain assessed from the apical 4-chamber and 2-chamber views and the circumferential and rotational mechanics measured from the apical short axis view. In comparison with controls, the patients with AS showed a significantly lower LV longitudinal (p < 0.001) and circumferential strain (p < 0.05) and higher apical rotation (p < 0.001). Following AVR, a significant improvement was seen in both strains (p < 0.001 for each respectively), however, apical rotation remained unchanged (p = 0.14). On multivariate analysis, baseline LV mass (odds ratio 1.02; p = 0.011), left atrial volume (odds ratio 0.81; p = 0.048) and circumferential strain (odds ratio 0.84; p = 0.02) independently predicted LV mass regression (>10 %) following AVR. In conclusion, STE can quantify the burden of myocardial dysfunction in patients with severe AS despite the presence of normal LV ejection fraction. Furthermore, resting abnormalities in circumferential strain at LV apex is related with a hemodynamic milieu associated with the lack of LV mass regression during short-term follow up after AVR.
authors.affiliation: 2nd Cardiology Department, Medical University of Silesia, Katowice, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Staron
authors.forename: Manish
authors.initials: M
authors.lastname: Bansal
authors.forename: Piyush
authors.initials: P
authors.lastname: Kalakoti
authors.forename: Ayumi
authors.initials: A
authors.lastname: Nakabo
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gasior
authors.forename: Piotr
authors.initials: P
authors.lastname: Pysz
authors.forename: Krystian
authors.initials: K
authors.lastname: Wita
authors.forename: Marek
authors.initials: M
authors.lastname: Jasinski
authors.forename: Partho P
authors.initials: PP
authors.lastname: Sengupta
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004452:Echocardiography / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left