scholarly journals Left ventricular force adaptation and cardiac deformation in the progression of aortic stenosis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
G Faganello ◽  
L Pagura ◽  
E Croatto ◽  
D Collia ◽  
S Furlotti ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Heart Diseases ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Cardiac Mechanics ◽  
Integrated Approach ◽  
Longitudinal Force ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Valvular Heart Diseases

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Aortic stenosis (AS) is one of the most common valvular heart diseases; however, the association between left ventricular (LV) myocardial deformation and hemodynamic forces (HDFs) is still mostly  unexplored. Purpose. This study aimed to assess the differences in LV myocardial deformation and HDFs in a large cohort of patients with aortic stenosis retrospectively. Methods. Two-hundred fifty-four subjects (median age 77 years, 50% women) with preserved LV ejection fraction (LVEF), and mild (n = 87), moderate (n = 92) or severe (n = 75) AS, were included in the study. The 2D LV global longitudinal strain (GLS), circumferential strain (GCS), and HDFs were measured with new software that allowed us to calculate all these values and parameters from the three apical views. Results. When comparing severe AS to mild AS, LV mass appeared increased while the LV hypertrophy phenotype was concentric (p <0.0001). Along with the progression of the AS, LVEF was decreased. All GLS, GCS, and HDFs parameters were uniformly reduced in severe AS compared to mild AS (p <0.0001), in the same way, LV longitudinal force, LV longitudinal systolic force, and LV impulse have proven to be accurate on ROC curves (AUC 70%, 73% and 73% respectively). Conclusion. The integrated approach of deformation and cardiac mechanics allows the description of pathophysiological changes during the progression of mild to severe aortic stenosis. Abstract Figure. Strain parameters and aortic stenosis

scholarly journals “Pure” severe aortic stenosis without concomitant valvular heart diseases: echocardiographic and pathophysiological features

2020 ◽  
Vol 36 (10) ◽  
pp. 1917-1929
Author(s):  
J. Kandels ◽  
B. Tayal ◽  
A. Hagendorff ◽  
D. Lavall ◽  
U. Laufs ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Heart Diseases ◽  
Severe Aortic Stenosis ◽  
Diagnostic Algorithm ◽  
Pulmonary Artery Hypertension ◽  
Left Ventricular ◽  
Low Flow ◽  
Effective Orifice Area ◽  
Valvular Heart Diseases ◽  
Mean Pressure

Abstract Purpose In echocardiography the severity of aortic stenosis (AS) is defined by effective orifice area (EOA), mean pressure gradient (mPGAV) and transvalvular flow velocity (maxVAV). The hypothesis of the present study was to confirm the pathophysiological presence of combined left ventricular hypertrophy (LVH), diastolic dysfunction (DD) and pulmonary artery hypertension (PAH) in patients with “pure” severe AS. Methods and Results Patients (n = 306) with asymptomatic (n = 133) and symptomatic (n = 173) “pure” severe AS (mean age 78 ± 9.5 years) defined by indexed EOA < 0.6 cm2 were enrolled between 2014 and 2016. AS patients were divided into 4 subgroups according to mPGAV and indexed left ventricular stroke volume: low flow (LF) low gradient (LG)-AS (n = 133), normal flow (NF) LG-AS (n = 91), LF high gradient (HG)-AS (n = 21) and NFHG-AS (n = 61). Patients with “pure” severe AS showed mean mPGAV of 31.7 ± 9.1 mmHg and mean maxVAV of 3.8 ± 0.6 m/s. Only 131 of 306 patients (43%) exhibited mPGAV > 40 mmHg and maxVAV > 4 m/s documenting incongruencies of the AS severity assessment by Doppler echocardiography. LVH was documented in 81%, DD in 76% and PAH in 80% of AS patients. 54% of “pure” AS patients exhibited all three alterations. Ranges of mPGAV and maxVAV were higher in patients with all three alterations compared to patients with less than three. 224 (73%) patients presented LG-conditions and 82 (27%) HG-conditions. LVH was predominant in NF-AS (p = 0.014) and PAH in LFHG-AS (p = 0.014). Patients’ treatment was retrospectively assessed (surgery: n = 100, TAVI: n = 48, optimal medical treatment: n = 156). Conclusion In patients with “pure” AS according to current guidelines the presence of combined LVH, DD and PAH as accepted pathophysiological sequelae of severe AS cannot be confirmed. Probably, the detection of these secondary cardiac alterations might improve the diagnostic algorithm to avoid overestimation of AS severity.

scholarly journals Role of Exercise Testing and Speckle Tracking Echocardiography in Paradoxical Severe Aortic Stenosis

2020 ◽  
Author(s):  
Belén Marí-López ◽  
María Manuela Izquierdo-Gómez ◽  
Ignacio Laynez-Cerdeña ◽  
Amelia Duque-González ◽  
Leopoldo Pérez de Isla ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Exercise Testing ◽  
Speckle Tracking ◽  
Multinomial Logistic Regression ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Clinical Behavior ◽  
Multinomial Logistic Regression Analysis

Abstract Background The clinical behavior and prognosis of patients with asymptomatic paradoxical low-gradient aortic stenosis (PLGAS) still remain controversial. Some authors consider PLGAS as an echocardiographically poorly quantified moderate AS (MAS). We aimed to investigate the clinical behavior of PLGAS by comparing it with that of asymptomatic high-gradient aortic stenosis (HG-AS) and MAS using transthoracic echocardiography (TTE) with speckle tracking imaging (STI) and cardiopulmonary exercise testing (CPET).Methods A cohort of 113 patients was included and categorized into three groups according to AS type: MAS (n=63), HG-AS (n=29), and PLGAS (n=21). Patients’ clinical data were obtained. Patients underwent 2D TTE with STI and CPET. Results There were no significant differences in the clinical variables between the three AS groups. In the multivariate multinomial logistic regression analysis, with PLGAS being the reference category, the most powerful variable for establishing a difference with HG-AS was the left ventricular mass (LVM) indexed by body-surface area (odds ratio [OR]=1.04, confidence interval [CI]=1.01-1.06, p<0.05). The MAS group showed a lower valvuloarterial impedance (OR=0.262, CI=0.12-0.59, p=0.001), fewer abnormal CPET (OR=0.198, CI=0.06-0.69, p<0.05), and higher left ventricle global longitudinal strain rate (GLSR) (OR=0.003, CI=0.00-0.35, p<0.05) than the PLGAS group.Conclusions TTE with STI and CPET established the clear differences between patients with asymptomatic PLGAS and those with asymptomatic MAS, as well as the similarities between patients with PLGAS and those with HG-AS. Our data identifies PLGAS as a completely different entity from MAS.

scholarly journals Myonecrosis in Aortic Valvular Heart Diseases

2009 ◽  
Vol 13 (Number 2) ◽  
pp. 9-12
Author(s):  
Md. Khalequzzaman ◽  
M A Islam ◽  
Md. O Hoque ◽  
M Ferdous ◽  
A H K Chowdhury ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Heart Diseases ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Definitive Treatment ◽  
Control Group ◽  
Cross Sectional ◽  
Valvular Heart Diseases ◽  
Significant Difference ◽  
Venous Sample

This cross sectional study was done among 20 patients with aortic stenosis and 20 healthy controls to evaluate the association of cardiac specific troponin 1 (ant) and sonic valvular heart diseases. The study was conducted in °militant, department in National laminae of Cardiovascular Diseases (N1CVD.)A structured queslionilaire and checklist was used to collect data through face to face interview. Color dapple, echocarchiognsphy was done and 5 ml of venous sample was dmwo from each subjects and laboratory estimation of an, was done. The arid in control group and sonic stenosis patients showed significant difference in mean (<0.001). ant level in aortic stenosis patients increases in the absence of heart failure indicating that it can expose the cardiotnyocnes to injury prior to development of oven left ventricular dysftinction. So. serial monitoring of aid may help clinicians to give definitive treatment (reface development af complications.

Segmentally impaired left ventricular longitudinal strain: a new predictive diagnostic parameter for asymptomatic patients with severe aortic stenosis and preserved ejection fraction

Perfusion ◽  
2021 ◽  
pp. 026765912199599
Author(s):  
Peggy M Kostakou ◽  
Elsie S Tryfou ◽  
Vassilios S Kostopoulos ◽  
Lambros I Markos ◽  
Dimitrios S Damaskos ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Average Strain ◽  
Asymptomatic Patients ◽  
Significant Difference

Introduction: This study aims to investigate the correlation between severe aortic stenosis (sAS) and impairment of left ventricular global longitudinal strain (LVGLS) in particular segments, using two-dimensional speckle tracking echocardiography in patients with sAS and normal ejection fraction of left ventricle (LVEF). Methods: The study included 53 consecutive patients with asymptomatic sAS and preserved LVEF. The regional longitudinal systolic LV wall strain was evaluated at the area opposite of the aorta as the median strain value of the basal, middle, and apical segments of the lateral and posterior walls and was compared to the average strain value of the interventricular septum (IVS) at the same views. Results: LVGLS was decreased and was not statistically different between three- and four-chamber views (−12.5 ± 3.6 vs −11.4 ± 5.5%, p = 0.2). The average strain values of the lateral and posterior walls were statistically reduced compared to the average value of the IVS (lateral vs IVS: −7.8 ± 3.7 vs −10 ± 5.3%, p = 0.005, posterior vs IVS: −7.7 ± 4.2 vs −10.3 ± 3.8%, p < 0.0001). There was no significant difference between lateral and posterior walls (−7.8 ± 3.7 vs −7.7 ± 4.2%, p = 0.9). Conclusions: The strain of lateral and posterior walls of left ventricle, which lay just opposite to the aortic valve seem to be more reduced compared to other walls in patients with sAS and preserved LVEF possibly due to their anatomical position. This impairment seems to be the reason of the overall LVGLS reduction. Regional strain could be used as an extra tool for the estimation of the severity of AS as well as for prognostic information in asymptomatic patients.

P305Prognostic value of relative apical sparing pattern of longitudinal strain in patients with severe aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Saito ◽  
M Imai ◽  
D Wake ◽  
R Higaki ◽  
T Sumimoto ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Primary Outcome ◽  
Proportional Hazards Model ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cardiac Events

Abstract Background The relative apical sparing pattern (RASP) of left ventricular longitudinal strain (LS) is determined on the strain polar map, while global longitudinal strain (GLS) is measured using speckle-tracking echocardiography and is frequently associated with cardiac amyloidosis (CA). According to recent reports, some elderly patients with aortic stenosis (AS) suffer from transthyretin CA and have a poor prognosis. Accordingly, we aimed to investigate the association of RASP and outcome of patients with severe AS. Methods We retrospectively studied 157 consecutive patients (age: 81±10 years, 33% men) with severe AS (mean transaortic pressure gradient: 49 mmHg) and preserved ejection fraction (>50%). After measuring GLS, RASP was semi-quantitatively and quantitatively assessed. Semi-quantitative RASP (sRASP) was defined as reduction of LS (more than −10%), showing light red or blue in ≥5 segments out of the basal six segments, relative to apical LS (less than −15%) showing red. This analysis was independently performed in a blinded manner by two observers. Quantitative RASP (qRASP) was calculated using the following formula: average apical LS/(average basal LS + average mid-ventricle LS), then qRASP ≥1 was determined as positive according to the previous paper. Patients were followed up to determine their outcomes, i.e., sudden cardiac death or unexpected admission due to heart failure over a median duration of 1.9 years. Concordance of sRASP was assessed using the kappa statistic, and a Cox proportional hazards model was used to assess the association between the parameters and primary outcome. Results The consistency in the observations of the two sonographers in identifying sRASP was found to be excellent (κ = 1.00). sRASP and qRASP were observed in 24 (15%) and 42 (27%) patients, respectively, and were significantly associated with the primary outcome (n=44; 28%). The representative case is shown in figure (left panel). Further, positive sRASP was associated with the outcome after adjusting for the Euro score, NYHA ≥II, and GLS (hazard ratio = 2.69, p=0.01). The model based on these covariates significantly improved following the addition of sRASP (Figure; right panel). In addition, sRASP was observed in four patients out of 50 patients who underwent aortic valve replacement. Of these, one patient had the primary outcome (25%). On the other hand, in the remaining 46 patients without sRASP, four patients had the outcome (9%). Figure 1 Conclusions RASP was observed in some patients with severe AS and has been shown to have increasing importance in predicting adverse cardiac events in such patients.

scholarly journals Left Ventricular Morphology and Function as a Determinant of Pulmonary Hypertension in Patients with Severe Aortic Stenosis: Cardiovascular Magnetic Resonance Imaging Study

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 711
Author(s):  
Birute Gumauskiene ◽  
Lina Padervinskiene ◽  
Jolanta Justina Vaskelyte ◽  
Audrone Vaitiekiene ◽  
Tomas Lapinskas ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
And Function

Background and Objectives: The influence of cardiac magnetic resonance (CMR) derived left ventricular (LV) parameters on the prognosis of patients with aortic stenosis (AS) was analyzed in several studies. However, the data on the relations between the LV parameters and the development of pulmonary hypertension (PH) in severe AS is lacking. Our objectives were to evaluate the CMR-derived changes of the LV size, morphology, and function in patients with isolated severe AS and PH, and to investigate the prognostic impact of these parameters on elevated systolic pulmonary artery pressure (sPAP). Materials and Methods: Thirty patients with isolated severe AS (aortic valve area ≤1 cm2) underwent a 2D-echocardiography (2D echo) and CMR before aortic valve replacement. Indices of the LV mass and volumes and ejection fraction were analyzed by CMR. The LV global longitudinal (LV LGS) and circumferential strain (LV CS) were calculated using CMR feature tracking (CMR-FT) software (Medis Suite QStrain 2.0, Medis Medical Imaging Systems B.V., Leiden, The Netherlands). The LV fibrosis expansion was assessed using a late gadolinium enhancement sequence. PH was defined as having an estimated sPAP of ≥45 mm Hg. The statistical analysis as performed using SPSS version 23.0 (SPSS, Chicago, IL, USA) Results: 30 patients with severe AS were included in the study, 23% with severe isolated AS had PH (mean sPAP 55 ± 6.6 mm Hg). More severe LV anatomical and functional abnormalities were observed in patients with PH when compared with patients without PH—a higher LV end-diastolic volume index (EDVi) (140 [120.0–160.0] vs. 90.0 mL/m² [82.5–103.0], p = 0.04), larger LV fibrosis area (7.8 [5.6–8.0] vs. 1.3% [1.2–1.5], p = 0.005), as well as lower LV global longitudinal strain (GLS; −14.0 [−14.9–(−8.9)] vs. −21.1% [−23.4–(−17.8)], p = 0.004). By receiver–operating characteristic (ROC) curve analysis, LV EDVi > 107.7 mL/m² (Area Under the Curve (AUC) 95.7%), LV GLS < −15.5% (AUC 86.3%), and LV fibrosis area >5% (AUC 89.3) were found to be robust predictors of PH in severe AS patients. Conclusions: In patients with severe aortic stenosis, a larger end-diastolic LV volume, impaired LV global longitudinal strain, and larger LV fibrosis extent can predict the development of pulmonary hypertension.

scholarly journals 657 Right ventricle systolic function and RV-PA coupling in patients with severe aortic stenosis and the early impact of TAVI

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Rosa Lillo ◽  
Francesca Graziani ◽  
Gessica Ingrasciotta ◽  
Bianca Przbybylek ◽  
Giulia Iannaccone ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Right Ventricle ◽  
Diastolic Function ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Early Effect ◽  
Few Data

Abstract Aims Few data are available on the prevalence of right ventricle (RV) systolic dysfunction, assessed including RV strain, and RV to pulmonary artery (PA) coupling in patients with aortic stenosis (AS) submitted to TAVI and the early effect of the procedure. Methods We performed standard and speckle tracking echocardiography in 80 patients with severe AS the day before TAVI and within 48 h after TAVI. In all patients we measured TAPSE/PASP (cut-off for RV-PA uncoupling 0.31) and in 60/80 we were able to analyse RV global longitudinal strain (RV-GLS) and RV free wall strain (RV-FWS). Results RV-FAC and TAPSE were impaired in 8.3% while RV-GLS and RV-FWS in 45% and 33% before TAVI. TAPSE/PASP&lt;0.31 was documented in 7/80 patients (8.7%) before TAVI. These subjects differed from patients with TAPSE/PASP&gt;0.31 for: enlarged left ventricular (LV) end-diastolic and end-systolic volumes (P&lt;0.001), worst LVEF (P&lt;0.001) and RVFAC (P&lt;0.001), worst RV-GLS and RW-FWS (P=0.01 and P=0.03) and bigger right atrium (RA) area (P&lt;0.001). After TAVI, RV systolic function did not improve while PASP significantly decreased (P=0.005) driving the improvement of TAPSE/PASP (P=0.01). Patients with TAPSE/PASP improvement (51%) differed from the others for worst pre-TAVI diastolic function (E/e’ P=0.045), RV-FAC (P=0.042), RV-GLS (P=0.049) and RA area (P=0.02). Conclusions RV-GLS unveils RV systolic dysfunction in as much as 45% of patients with AS vs. only 8.3% revealed by conventional echocardiography. RV systolic function does not significantly improve early after TAVI while RV-PA coupling does. Patients with lower TAPSE/PASP at baseline have worst LV and RV systolic function as well as larger RA. Patients who improve TAPSE/PASP after TAVI are those with worst diastolic function, RV systolic function and larger RA at baseline.

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