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.
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.
Authors: Iacopo Fabiani; Lorenzo Conte; Nicola Riccardo Pugliese; Enrico Calogero; Valentina Barletta; Rossella Di Stefano; Tatiana Santoni; Cristian Scatena; Uberto Bortolotti; Antonio Giuseppe Naccarato; Anna Sonia Petronio; Vitantonio Di Bello Journal: Int J Cardiovasc Imaging Date: 2017-06-29 Impact factor: 2.357
Authors: Heather A Stefek; Haben Berhane; Joshua D Robinson; Brian Reilly; Alexander Ruh; Michael Markl; Cynthia K Rigsby Journal: Pediatr Cardiol Date: 2019-07-24 Impact factor: 1.655
Authors: E Mara Vollema; Tadafumi Sugimoto; Mylène Shen; Lionel Tastet; Arnold C T Ng; Rachid Abou; Nina Ajmone Marsan; Bart Mertens; Raluca Dulgheru; Patrizio Lancellotti; Marie-Annick Clavel; Philippe Pibarot; Philippe Genereux; Martin B Leon; Victoria Delgado; Jeroen J Bax Journal: JAMA Cardiol Date: 2018-09-01 Impact factor: 14.676