Alterations in Layer-Specific Left Ventricular Global Longitudinal and Circumferential Strain in Patients With Aortic Stenosis: A Comparison of Aortic Valve Replacement versus Conservative Management Over a 12-Month Period - 03/01/19
, Liza Thomas, PhD a, b, c, d, Dominic Y. Leung, PhD a, bAbstract |
Background |
Impairment in left ventricular (LV) systolic strain in aortic stenosis (AS) is well documented. However, alterations in layer-specific LV global longitudinal strain (GLS) and global circumferential strain (GCS) and their recovery following surgical aortic valve replacement (AVR) have not been established. The aim of this study was to examine layer-specific changes in GLS and GCS in patients with AS undergoing AVR and compare these patients with those managed conservatively over 12 months.
Methods |
Eighty-six patients (mean age, 68.8 ± 12 years; 60 men) with AS (19 mild, 15 moderate, and 52 severe) were prospectively recruited. Patients with coronary disease or other significant valvular disease were excluded. Forty patients (46.5%) with severe AS underwent AVR. All patients underwent baseline echocardiography. Patients managed conservatively underwent follow-up echocardiography at 12 months. Patients undergoing AVR underwent follow-up echocardiography at 1 week and 3, 6, and 12 months after AVR.
Results |
There was worsening in subendocardial but not subepicardial or transmural GLS even in mild AS (−20.9 ± 1.0% vs −20.6 ± 0.8%, P = .012). In moderate AS, worsening in subendocardial (−19.6 ± 0.9% vs −18.2 ± 1.5%, P = .003), subepicardial (−14.9 ± 1.0% vs −13.8 ± 1.2%, P = .004), and transmural (−17.1 ± 0.9% vs −15.8 ± 1.3%, P = .03) GLS and a trend toward significant worsening in subendocardial GCS (−29.8 ± 5.16% vs −27.5 ± 5%, P = .054) were seen. Conservatively managed patients with severe AS had significant worsening in subendocardial (−16.1 ± 1.6% vs −13.9 ± 2.6%, P = .021), subepicardial (−11.6 ± 1.1% vs −10.1 ± 2.1%, P = .027), and transmural (−13.6 ± 1.3% vs −11.8 ± 2.3%, P = .02) GLS and subendocardial (−24.9 ± 3.6% vs −20.8 ± 4.5%, P = .002) and transmural (−16.9 ± 1.7% vs −14.3 ± 3.5%, P = .04) GCS on follow-up. Patients after AVR demonstrated significant improvement in GLS (from 3 months) and GCS (from 6 months) in both myocardial layers.
Conclusions |
Patients with AS managed conservatively had worsening of GLS over 12 months despite preserved LV ejection fraction, detected earliest in the subendocardial layer. GCS became progressively impaired in moderate and severe AS. Improvement in LV strain after AVR was seen earlier with GLS (from 3 months) than with GCS (from 6 months) in both myocardial layers.
Le texte complet de cet article est disponible en PDF.Highlights |
• | AS causes differential strain impairment in different myocardial layers. |
• | Progression in strain impairment is detectable earlier in the subendocardial layer. |
• | GLS is affected earlier than and recovers before GCS after aortic valve surgery. |
Keywords : Aortic stenosis, Left ventricular function, Multidirectional strain, Layer-specific strain, Speckle-tracking strain echocardiography, Aortic valve replacement
Abbreviations : AS, AVR, GCS, GLS, ICC, LV, LVEF, LVH
Plan
| Conflicts of Interest: None. |
Vol 32 - N° 1
P. 92-101 - janvier 2019 Retour au numéro
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