Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: A two-dimensional speckle tracking analysis

Ng, Arnold C.T., Delgado, Victoria, Bertini, Matteo, Antoni, Marie Louisa, van Bommel, Rutger J., van Rijnsoever, Eva P.M., van der Kley, Frank, Ewe, See Hooi, Witkowski, Tomasz, Auger, Dominique, Nucifora, Gaetano, Schuijf, Joanne D., Poldermans, Don, Leung, Dominic Y., Schalij, Martin J. and Bax, Jeroen J. (2011) Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: A two-dimensional speckle tracking analysis. European Heart Journal, 32 12: 1542-1550. doi:10.1093/eurheartj/ehr084


Author Ng, Arnold C.T.
Delgado, Victoria
Bertini, Matteo
Antoni, Marie Louisa
van Bommel, Rutger J.
van Rijnsoever, Eva P.M.
van der Kley, Frank
Ewe, See Hooi
Witkowski, Tomasz
Auger, Dominique
Nucifora, Gaetano
Schuijf, Joanne D.
Poldermans, Don
Leung, Dominic Y.
Schalij, Martin J.
Bax, Jeroen J.
Title Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: A two-dimensional speckle tracking analysis
Journal name European Heart Journal   Check publisher's open access policy
ISSN 0195-668X
1522-9645
Publication date 2011-06-01
Year available 2011
Sub-type Article (original research)
DOI 10.1093/eurheartj/ehr084
Open Access Status Not yet assessed
Volume 32
Issue 12
Start page 1542
End page 1550
Total pages 9
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Subject 2705 Cardiology and Cardiovascular Medicine
Abstract AimsTo identify changes in multidirectional strain and strain rate (SR) in patients with aortic stenosis (AS).Methods and resultsA total of 420 patients (age 66.1 ± 14.5 years, 60.7 men) with aortic sclerosis, mild, moderate, and severe AS with preserved left ventricular (LV) ejection fraction [(EF), <50] were included. Multidirectional strain and SR imaging were performed by two-dimensional speckle tracking. Patients were more likely to be older (P < 0.001) and at a worse New York Heart Association functional class (P < 0.001) with increasing AS severity. There was a progressive stepwise impairment in longitudinal, circumferential, and radial strain and SR with increasing AS severity (all P < 0.001). The myocardial dysfunction appeared to start in the subendocardium with mild AS, to mid-wall dysfunction with moderate AS, and eventually transmural dysfunction with severe AS. Aortic valve area, as a measure of AS severity, was an independent determinant of multidirectional strain and SR on multiple linear regressions.ConclusionsPatients with AS have evidence of subclinical myocardial dysfunction early in the disease process despite normal LVEF. The myocardial dysfunction appeared to start in the subendocardium and progressed to transmural dysfunction with increasing AS severity. Symptomatic moderate and severe AS patients had more impaired multidirectional myocardial functions compared with asymptomatic patients.
Formatted abstract
Aims: To identify changes in multidirectional strain and strain rate (SR) in patients with aortic stenosis (AS).

Methods and results: A total of 420 patients (age 66.1 ± 14.5 years, 60.7% men) with aortic sclerosis, mild, moderate, and severe AS with preserved left ventricular (LV) ejection fraction [(EF), ≥50%] were included. Multidirectional strain and SR imaging were performed by two-dimensional speckle tracking. Patients were more likely to be older (P < 0.001) and at a worse New York Heart Association functional class (P < 0.001) with increasing AS severity. There was a progressive stepwise impairment in longitudinal, circumferential, and radial strain and SR with increasing AS severity (all P < 0.001). The myocardial dysfunction appeared to start in the subendocardium with mild AS, to mid-wall dysfunction with moderate AS, and eventually transmural dysfunction with severe AS. Aortic valve area, as a measure of AS severity, was an independent determinant of multidirectional strain and SR on multiple linear regressions.

Conclusions: Patients with AS have evidence of subclinical myocardial dysfunction early in the disease process despite normal LVEF. The myocardial dysfunction appeared to start in the subendocardium and progressed to transmural dysfunction with increasing AS severity. Symptomatic moderate and severe AS patients had more impaired multidirectional myocardial functions compared with asymptomatic patients.
Keyword Aortic stenosis
Aortic valve
Left ventricle
Echocardiography
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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