Increased valvulo-arterial impedance differently impacts left ventricular longitudinal, circumferential, and radial function in patients with aortic stenosis: A speckle tracking echocardiography study

2016 ◽  
Vol 34 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Elena Galli ◽  
Alain Leguerrier ◽  
Erwan Flecher ◽  
Christophe Leclercq ◽  
Erwan Donal
Keyword(s):  
Aortic Stenosis ◽  
Speckle Tracking ◽  
Radial Function ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Arterial Impedance

scholarly journals Dissecting myocardial mechanics in patients with severe aortic stenosis: 2-dimensional vs 3-dimensional-speckle tracking echocardiography

2020 ◽  
Author(s):  
Xiaojun Bi ◽  
Darwin F Yeung ◽  
Husam M. Salah ◽  
Maria C. Arciniegas Calle ◽  
Jeremy J. Thaden ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Normal Values ◽  
Left Ventricular ◽  
3 Dimensional ◽  
Arterial Impedance ◽  
Apical Rotation ◽  
2D And 3D ◽  
The Impact

Abstract Background: Aortic stenosis (AS) causes left ventricular (LV) pressure overload, leading to adverse LV remodeling and dysfunction. Identifying early subclinical markers of LV dysfunction in patients with significant AS is critical as this could provide support for earlier intervention, which may result in improved long-term outcomes. We therefore examined the impact of severe AS and its consequent increase in LV afterload on myocardial deformation and rotational mechanics by 2-dimensional (2D) and 3-dimensional (3D) speckle-tracking echocardiography. Methods: We prospectively measured various strain parameters in 168 patients (42% female, mean age 72±12 years) with severe AS and LV ejection fraction (EF) ≥50%, and compared them to normal values found in literature. 2D and 3D images were analyzed for global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), basal rotation, apical rotation, and peak systolic twist. We further assessed the degree of concordance between 2D and 3D strain, and examined their association with measures of LV preload and afterload. Results: Patients with severe AS exhibited significantly lower GLS and GRS but higher GCS, apical rotation, and twist by 2D and 3D echocardiography compared with published normal values (P=0.003 for 3D twist,P<0.001 for all others). Agreement between 2D- and 3D-GLS by concordance correlation coefficient was 0.49 (95% confidence interval: 0.39-0.57). GLS was correlated with valvulo-arterial impedance, a measure of LV afterload (r=0.34, p<0.001 and r=0.23, p=0.003, respectively). Conclusion: Patients with severe AS demonstrated lower-than-normal GLS and GRS but appear to compensate with higher-than-normal GCS, apical rotation, and twist in order to maintain a preserved LVEF. GLS showed a modest correlation with valvulo-arterial impedance.

P91 Prognostic value of tissue-tracking mitral annular displacement by speckle-tracking echocardiography in asymptomatic patients with aortic stenosis with preserved left ventricular ejection fraction

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
I Teraguchi ◽  
T Hozumi ◽  
H Emori ◽  
K Takemoto ◽  
N Maniwa ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Longitudinal Deformation ◽  
Cardiac Events ◽  
Tissue Tracking

Abstract Background   Management of asymptomatic severe aortic stenosis (AS) patients with preserved left ventricular (LV) ejection fraction (EF) remains controversial. Recent studies using have shown that decreased LV longitudinal deformation assessed by global longitudinal strain analysis can predict adverse cardiac events in AS patients with preserved EF. Tissue-tracking mitral annular displacement (TMAD) by speckle-tracking echocardiography provides rapid and simple assessment of LV longitudinal deformation even when the acoustic window is poor (Fig.1). Purpose  The purpose of this study was to examine the value of TMAD to predict occurrence of the cardiac events in asymptomatic severe AS patients with preserved EF. Methods   We studied 103 patients with severe AS and preserved EF [aortic velocity &gt;4m/s or aortic valve area (AVA) &lt;1.0 cm2, EF &gt;50%]in whom TMAD was measured, and a total of 44 patients were included in the final data setaccording to the exclusion criteria. Using TMAD analysis software, the base-to-apex displacement of automatically defined mid-point of mitral annular line in four-chamber view was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated (Fig.1). We investigated the association between %TMAD and the cardiac events including implementation of hospitalization due to heart failure, decreased EF (&lt; 50%), aortic valve replacement or transcatheter aortic valve implantation due to appearance of symptoms and cardiac death,  Results  In all the final study patients, %TMAD was successfully and quickly (within 10 seconds) evaluated. During a follow-up, the cardiac events developed in 16 (36%) of 44 patients. Tableshows echocardiographic parameters in patients with and without the cardiac events. %TMAD was significantly impaired in patients with the cardiac events compared with those without the cardiac events (9.6 ± 0.6 vs 12.1 ± 0.4%, p= 0.002). The other parameters were not involved in the event occurrence; age, LV mass index, EF, aortic velocity, AVA, tricuspid regurgitation pressure gradient (TR-PG), early diastolic /atrial filling velocity (E/A), early diastolic velocity of the mitral valve annulus (e’) and E/e’. In multiple variable analysis, %TMAD was an independentpredictor of the cardiac events (HR; 12.1, p= 0.001). ROC analysis revealed that the area under the curve of %TMAD was 0.81 for the cardiac events. Kaplan-Meier analysis showed %TMAD (cut-off: 11.9) provides a significant difference in the cardiac event (Fig. 2). Conclusions.  The present results suggests that TMAD easily and rapidly estimated by speckle-tracking echocardiography can be used as a simple method to predict occurrence of the cardiac events in asymptomatic severe AS patients with preserved EF. Abstract P91 Figure 1,2 and Table

scholarly journals P313 Prognostic value of automated measurement of mitral annular displacement by speckle-tracking echocardiography in asymptomatic aortic stenosis patients with preserved left ventricular ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Hozumi ◽  
I Teraguchi ◽  
K Takemoto ◽  
S Fujita ◽  
T Wada ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Speckle Tracking ◽  
Prognostic Value ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Study Population

Abstract Background Management of patients with asymptomatic severe aortic stenosis (AS) and preserved left ventricular (LV) ejection fraction (EF) remains controversial. Recent studies have shown prognostic value of decreased LV global longitudinal strain in AS patients with preserved LVEF. Tissue-tracking mitral annular displacement (TMAD) in single apical four-chamber view (AP4) by speckle-tracking echocardiography provides automated rapid assessment of LV longitudinal deformation (Figure). This simple method may be useful for the prediction of cardiac events in asymptomatic severe AS patients with preserved LVEF. Purpose The purpose of this study was to examine the value of TMAD to predict cardiac events in asymptomatic severe AS patients with preserved LVEF. Methods The study population consisted of 103 patients with severe AS and preserved LVEF [aortic velocity &gt;4m/s or aortic valve area (AVA) &lt;1.0 cm², LVEF &gt;50%]. After exclusion of 56 patients who met the exclusion criteria (symptomatic, atrial fibrillation, significant mitral valve diseases, history of cardiac surgery, short follow-up period &lt;120 days, and inadequate echocardiographic images), the final study population consisted of 47 patients. Using TMAD analysis software (QLAB 10.5, Philips), the base-to-apex displacement of automatically defined mid-point of mitral annular line in AP4 was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated . We investigated the occurrence of the cardiac events including appearance of symptoms, decreased LVEF (&lt; 50%), and cardiac death. Results %TMAD was successfully and quickly evaluated in 44 (94%) of 47 patients. During a follow-up, the cardiac events developed in 16 (36%) of 44 patients. %TMAD was significantly impaired in patients with the cardiac events compared with those without the cardiac events (9.6 ± 1.9 vs 12.1 ± 2.6%, p= 0.002). There were no significant differences in the other parameters including age, LVEF, aortic velocity, AVA, tricuspid regurgitation pressure gradient, early diastolic /atrial filling velocity (E/A), early diastolic velocity of the mitral valve annulus (e’) and E/e’ between the patients with and without the cardiac events. Receiver operating characteristic analysis revealed that area under the curve of %TMAD was 0.81 for the cardiac events. Kaplan-Meier analysis showed %TMAD (cut-off: 11.9) provides a significant difference in the cardiac events (hazard ratio 14.8, 95% CI, 2.75-79.3; p= 0.002). Conclusions The present results suggest that automated TMAD measurement by speckle-tracking echocardiography may be useful to predict cardiac events in asymptomatic severe AS patients with preserved LVEF. Abstract P313 Figure

scholarly journals Dissecting Myocardial Mechanics in Patients with Severe Aortic Stenosis: 2-Dimensional vs 3-Dimensional-Speckle Tracking Echocardiography

2019 ◽  
Author(s):  
Xiaojun Bi ◽  
Darwin F Yeung ◽  
Husam M. Salah ◽  
Maria C. Arciniegas Calle ◽  
Jeremy J. Thaden ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Normal Values ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
3 Dimensional ◽  
Apical Rotation ◽  
Rotational Mechanics ◽  
2D And 3D

Abstract Background: Aortic stenosis (AS) causes left ventricular (LV) pressure overload, leading to adverse LV remodeling and dysfunction. We examined the impact of severe AS and its consequent increase in LV afterload on myocardial deformation and rotational mechanics by 2-dimensional (2D) and 3-dimensional (3D) speckle-tracking echocardiography. Methods: We prospectively measured various strain parameters in 168 patients (42% female, mean age 72±12 years) with severe AS and LV ejection fraction (EF) ≥50%, and compared them to normal values found in literature. 2D and 3D images were analyzed for global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), basal rotation, apical rotation, and peak systolic twist. We further assessed the degree of concordance between 2D and 3D strain, and examined their association with measures of LV preload and afterload. Results: Patients with severe AS exhibited significantly lower GLS and GRS but higher GCS, apical rotation, and twist by 2D and 3D echocardiography compared with published normal values (P=0.003 for 3D twist,P<0.001 for all others). There was modest agreement between 2D and 3D GLS measurements (concordance correlation coefficient 0.49, 95% confidence interval 0.39-0.57). GLS was modestly correlated with valvulo-arterial impedance, a measure of LV afterload (r=0.34, p<0.001 for 2D and r=0.23, p=0.003 for 3D). Conclusion: Patients with severe AS demonstrate lower-than-normal GLS and GRS as a result of increased afterload but appear to compensate with higher-than-normal GCS, apical rotation, and twist in order to maintain a preserved LVEF. Our study provides, to our knowledge, the most comprehensive analysis to date of myocardial deformation and rotational mechanics by 2D and 3D speckle-tracking echocardiography in patients with severe AS and preserved LVEF.

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