title: Left Ventricular Contraction Pattern in Chronic Aortic Regurgitation and Preserved Ejection Fraction: Simultaneous Stress-Strain Analysis by Three-Dimensional Echocardiography.
abstract: BACKGROUND
  The role of speckle-tracking echocardiography in the assessment of chronic aortic regurgitation (AR) is not established. Load dependency may encumber the interpretation of strain measurements in the chronically overloaded left ventricle. The aim of this study was to investigate the mechanisms of left ventricular (LV) contraction patterns in asymptomatic patients with moderate to severe AR and preserved ejection fractions.
  
  
  METHODS
  In this prospective, cross-sectional study, 31 patients with moderate to severe AR, 15 elite endurance athletes, and 17 healthy control subjects were examined using three-dimensional speckle-tracking echocardiography. Global circumferential strain (GCS), global longitudinal strain (GLS), end-systolic circumferential wall stress (ESSc), end-systolic meridional wall stress (ESSm), and the wall stress ratio (ESSc/ESSm) were measured.
  
  
  RESULTS
  LV end-diastolic volumes were similar in athletes and patients with AR and significantly larger than in healthy control subjects. Values of GLS in control subjects, athletes, and patients with AR were -18.8 ± 1.9%, -17.3 ± 2.0%, and -16.4± 2.0%, respectively (control subjects vs athletes and patients, P < .05), whereas values of GCS were -16.9 ± 2.0%, -15.5 ± 1.9%, and -17.9 ± 2.6%, respectively (athletes vs control subjects and patients, P < .01). The ESSc/ESSm ratio was lower in patients with AR (P < .01). When adjusted for ESSm, GLS remained impaired in patients compared with control subjects and athletes (P = .015). On the other hand, GCS was better in patients with AR when adjusted for ESSc (P = .003).
  
  
  CONCLUSIONS
  In compensated AR, relatively high GCS compensates for reduced GLS in a manner consistent with the preserved ejection fractions observed in these patients.
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway; Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Norway. Electronic address: kaspar.broch@ous-hf.no.
authors.forename: Kaspar
authors.initials: K
authors.lastname: Broch
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Stefano F
authors.initials: SF
authors.lastname: de Marchi
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Richard
authors.initials: R
authors.lastname: Massey
authors.affiliation: Department of Vascular Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Jonny
authors.initials: J
authors.lastname: Hisdal
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway; Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.
authors.forename: Stig
authors.initials: S
authors.lastname: Urheim
mesh_terms: D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002908:Chronic Disease; D019245:Compressive Strength; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D013314:Stress, Mechanical; D013318:Stroke Volume; D013718:Tensile Strength; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*
keywords: Aortic regurgitation; Echocardiography; Left ventricular function; Speckle-tracking; Wall stress