title: Aortic Valve Disease and Vascular Mechanics: Two-Dimensional Speckle Tracking Echocardiographic Analysis.
abstract: OBJECTIVE
  Degenerative aortic valve disease (AVD) is a complex disorder that goes beyond valve itself, also undermining aortic wall. We aimed to assess the ascending aortic mechanics with two-dimensional speckle tracking echocardiography (2DSTE) in patients with aortic regurgitation (AR) and hypothesized a relationship with degree of AR. Aortic mechanics were then compared with those of similarly studied healthy controls and patients with aortic stenosis (AS); finally, we aimed to assess the prognostic significance of vascular mechanics in AVD.
  
  
  METHODS
  Overall, 73 patients with moderate-to-severe AR and 22 healthy subjects were enrolled, alongside a previously examined cohort (N = 45) with moderate-to-severe AS. Global circumferential ascending aortic strain (CAAS) and strain rate (CAASR) served as indices of aortic deformation; corrected CAAS was calculated as CAAS/pulse pressure (PP). Median clinical follow-up was 438 days.
  
  
  RESULTS
  In patients with severe (vs. moderate) AR, CAASR (1.53 ± 0.29/sec vs. 1.90 ± 0.62/sec, P < 0.05) and corrected CAAS (0.14 ± 0.06%/mmHg vs. 0.19 ± 0.08%/mmHg, P < 0.05) were significantly lower, whereas CAAS did not differ significantly. Measurers of aortic mechanics (CAAS, corrected CAAS, CAASR) differed significantly (all P < 0.01) in patients with AS and AR and in healthy subjects, with lower values seen in patients with AS. In follow-up, survival rate of AVD patients with baseline CAASR >0.88/sec was significantly higher (log rank, 97.4% vs. 73.0%; P = 0.03).
  
  
  CONCLUSIONS
  Quantitative measures of aortic mechanics were lower for AS patients, suggesting a more significant derangement of aortic elastic properties. In the context of AVD, vascular mechanics assessment proved useful in gauging clinical prognosis.
authors.affiliation: Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal.
authors.forename: Luís
authors.identifier: http://orcid.org/0000-0002-8493-6935
authors.initials: L
authors.lastname: Leite
authors.affiliation: Department of Cardiology, General Unit, Coimbra Hospital and University Center, Coimbra, Portugal.|Faculty of Medicine of the University of Coimbra, Coimbra, Portugal.
authors.forename: Rogério
authors.initials: R
authors.lastname: Teixeira
authors.affiliation: Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Oliveira-Santos
authors.affiliation: Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Barbosa
authors.affiliation: Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Martins
authors.affiliation: Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal.
authors.forename: Graça
authors.initials: G
authors.lastname: Castro
authors.affiliation: Department of Cardiology, General Unit, Coimbra Hospital and University Center, Coimbra, Portugal.|Faculty of Medicine of the University of Coimbra, Coimbra, Portugal.
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
authors.affiliation: Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal.
authors.forename: Mariano
authors.initials: M
authors.lastname: Pego
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data; D055119:Elastic Modulus; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis
keywords: aortic mechanics; aortic regurgitation; aortic stenosis; strain; strain rate; two-dimensional speckle tracking echocardiography