Detection of subtle left ventricular systolic dysfunction in patients with significant aortic regurgitation and preserved left ventricular ejection fraction: speckle tracking echocardiographic analysis.
OBJECTIVE
The aim of this study was to characterize left ventricular (LV) mechanics in symptomatic and asymptomatic patients with moderate-to-severe or severe aortic regurgitation (AR) and preserved ejection fraction (left ventricular ejection fraction) using two-dimensional speckle tracking echocardiography (2D-STE). The association between baseline LV strain and development of indications for surgery in asymptomatic patients was also evaluated.


RESULTS
A total of 129 patients with moderate-to-severe or severe AR and LVEF >50% (age 55 ± 17 years, 64% male, 53% asymptomatic at baseline) were included. Standard echocardiography and 2D-STE were performed at baseline. Compared with asymptomatic patients, symptomatic patients had significantly impaired LV longitudinal (-14.9 ± 3.0 vs. -16.8 ± 2.5%, P < 0.001), circumferential (-17.5 ± 2.9 vs. -19.3 ± 2.8%, P = 0.001), and radial (35.7 ± 12.2 vs. 43.1 ± 14.7%, P = 0.004) strains. Among 49 asymptomatic patients who were followed up, 26 developed indications for surgery (symptoms onset or LVEF ≤50%). These patients had comparable LV volumes, LVEF, and colour Doppler assessments of AR jet at baseline, but more impaired LV longitudinal (P = 0.009) and circumferential (P = 0.017) strains compared with patients who remained asymptomatic. Impaired baseline LV longitudinal (per 1% decrease, HR = 1.21, P = 0.04) or circumferential (per 1% decrease, HR = 1.22, P = 0.04) strain was independently associated with the need for surgery.


CONCLUSIONS
Multidirectional LV strain was more impaired in symptomatic than in asymptomatic patients with moderate-to-severe or severe AR, despite preserved LVEF. In asymptomatic AR patients, longitudinal and circumferential strains identified patients who would require surgery during follow-up.
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands Department of Cardiology, National Heart Centre, Singapore.
See Hooi
SH
Ewe
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands.
Marlieke L A
ML
Haeck
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.
Arnold C T
AC
Ng
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands.
Tomasz G
TG
Witkowski
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands.
Dominique
D
Auger
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands.
Darryl P
DP
Leong
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands.
Elena
E
Abate
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands.
Nina
N
Ajmone Marsan
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands.
Eduard R
ER
Holman
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands.
Martin J
MJ
Schalij
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands.
Jeroen J
JJ
Bax
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, The Netherlands v.delgado@lumc.nl.
Victoria
V
Delgado
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D016022:Case-Control Studies; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods*; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D009426:Netherlands; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality
Aortic regurgitation; Echocardiography; Ejection fraction; Speckle tracking; Surgery