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

Autor: Arnold C.T. Ng, Jeroen J. Bax, Tomasz Witkowski, Marlieke L.A. Haeck, Nina Ajmone Marsan, Dominique Auger, Darryl P. Leong, See Hooi Ewe, Eduard R. Holman, Martin J. Schalij, Victoria Delgado, Elena Abate
Rok vydání: 2015
Předmět:
Adult
Male
Ejection fraction
medicine.medical_specialty
Aortic Valve Insufficiency
Aortic regurgitation
Speckle tracking echocardiography
Severity of Illness Index
Asymptomatic
Ventricular Dysfunction
Left
Predictive Value of Tests
Internal medicine
Image Interpretation
Computer-Assisted
Severity of illness
medicine
Humans
Radiology
Nuclear Medicine and imaging
Survival rate
Aged
Monitoring
Physiologic
Netherlands
Proportional Hazards Models
Speckle tracking
Analysis of Variance
business.industry
Stroke Volume
General Medicine
Stroke volume
Middle Aged
Prognosis
medicine.disease
Survival Rate
ROC Curve
Echocardiography
Case-Control Studies
Heart failure
Predictive value of tests
Multivariate Analysis
Disease Progression
Cardiology
Female
Surgery
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Heart Failure
Systolic
Zdroj: European Heart Journal-Cardiovascular Imaging, 16(9), 992-999
ISSN: 2047-2412
2047-2404
Popis: 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.
Databáze: OpenAIRE
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