Detection of subtle left ventricular systolic dysfunction in patients with significant aortic regurgitation and preserved left ventricular ejection fraction: speckle tracking echocardiographic analysis

Ewe, See Hooi, Haeck, Marlieke L. A., Ng, Arnold C. T., Witkowski, Tomasz G., Auger, Dominique, Leong, Darryl P., Abate, Elena, Marsan, Nina Ajmone, Holman, Eduard R., Schalij, Martin J., Bax, Jeroen J. and Delgado, Victoria (2015) Detection of subtle left ventricular systolic dysfunction in patients with significant aortic regurgitation and preserved left ventricular ejection fraction: speckle tracking echocardiographic analysis. European Heart Journal-Cardiovascular Imaging, 16 9: 992-999. doi:10.1093/ehjci/jev019


Author Ewe, See Hooi
Haeck, Marlieke L. A.
Ng, Arnold C. T.
Witkowski, Tomasz G.
Auger, Dominique
Leong, Darryl P.
Abate, Elena
Marsan, Nina Ajmone
Holman, Eduard R.
Schalij, Martin J.
Bax, Jeroen J.
Delgado, Victoria
Title Detection of subtle left ventricular systolic dysfunction in patients with significant aortic regurgitation and preserved left ventricular ejection fraction: speckle tracking echocardiographic analysis
Journal name European Heart Journal-Cardiovascular Imaging   Check publisher's open access policy
ISSN 2047-2404
2047-2412
Publication date 2015-09
Year available 2015
Sub-type Article (original research)
DOI 10.1093/ehjci/jev019
Open Access Status Not Open Access
Volume 16
Issue 9
Start page 992
End page 999
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2016
Language eng
Formatted abstract
Aims The aim of this study was to characterize left ventricular (LV) mechanics in symptomatic and asymptomatic patients with moderate-to-severe or severe aortic regurgitation (AR) and preserved ejection fraction (left ventricular ejection fraction) using two-dimensional speckle tracking echocardiography (2D-STE). The association between baseline LV strain and development of indications for surgery in asymptomatic patients was also evaluated.

Methods and results
A total of 129 patients with moderate-to-severe or severe AR and LVEF >50% (age 55 ± 17 years, 64% male, 53% asymptomatic at baseline) were included. Standard echocardiography and 2D-STE were performed at baseline. Compared with asymptomatic patients, symptomatic patients had significantly impaired LV longitudinal (−14.9 ± 3.0 vs. −16.8 ± 2.5%, P < 0.001), circumferential (−17.5 ± 2.9 vs. −19.3 ± 2.8%, P = 0.001), and radial (35.7 ± 12.2 vs. 43.1 ± 14.7%, P = 0.004) strains. Among 49 asymptomatic patients who were followed up, 26 developed indications for surgery (symptoms onset or LVEF ≤50%). These patients had comparable LV volumes, LVEF, and colour Doppler assessments of AR jet at baseline, but more impaired LV longitudinal (P = 0.009) and circumferential (P = 0.017) strains compared with patients who remained asymptomatic. Impaired baseline LV longitudinal (per 1% decrease, HR = 1.21, P = 0.04) or circumferential (per 1% decrease, HR = 1.22, P = 0.04) strain was independently associated with the need for surgery.

Conclusion Multidirectional LV strain was more impaired in symptomatic than in asymptomatic patients with moderate-to-severe or severe AR, despite preserved LVEF. In asymptomatic AR patients, longitudinal and circumferential strains identified patients who would require surgery during follow-up.
Keyword Aortic regurgitation
Echocardiography
Speckle tracking
Surgery
Ejection fraction
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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