title: Left Ventricular Strain as Predictor of Chronic Aortic Regurgitation.
abstract: BACKGROUND
  It is not well known about the implication of left ventricular (LV) strain as a predictor for mortality in patients with chronic aortic regurgitation (AR). The purpose of this study was to investigate whether global longitudinal strain measured by two-dimensional speckle-tracking echocardiography could predict long-term outcome in patients with chronic AR.
  
  
  METHODS
  This is a single center non-randomized retrospective observational study. The patients with chronic AR from January 2002 to December 2012 were retrospectively enrolled. Following patients were excluded; combined other significant valvular disease, previous heart surgery, aortic disease, congenital heart disease, acute AR and young age under 18 years old. Finally, 60 patients were analyzed and the LV global strain rate was measured on apical four chamber image (GS-4CH).
  
  
  RESULTS
  During 64 months follow-up duration, 16 patients (26.7%) were deceased and 38 patients (63.3%) underwent aortic valve replacement (AVR). Deceased group was older (69 years old vs. 51 years old, p < 0.001) and had lower longitudinal strain (-12.05 ± 3.72% vs. -15.66 ± 4.35%, p = 0.005). Kaplan-Meier survival curve stratified by GS-4CH showed a trend of different event rate (log rank p = 0.001). On multivariate analysis by cox proportional hazard model adjusting for age, sex, body surface area, history of atrial fibrillation, blood urea nitrogen, LV dilatation, LV ejection fraction and AVR, decreased GS-4CH proved to be an independent predictor of mortality in patients with chronic AR (hazard ratio 1.313, 95% confidence interval 1.010-1.706, p = 0.042).
  
  
  CONCLUSIONS
  GS-4CH may be a useful predictor of mortality in patient with chronic AR.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Young Ae
authors.initials: YA
authors.lastname: Yang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Kyu Yeon
authors.initials: KY
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Sang Mi
authors.initials: SM
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Hong Nyun
authors.initials: HN
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Se Yong
authors.initials: SY
authors.lastname: Jang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Myung Hwan
authors.initials: MH
authors.lastname: Bae
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Jang Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Dong Heon
authors.initials: DH
authors.lastname: Yang
keywords: Chronic aortic regurgitation; Left ventricular strain; Mortality