Global left ventricular longitudinal strain values ≥-18.5% significantly predicted the deterioration of left ventricular ejection fraction in asymptomatic aortic regurgitation (AUC 0.89, P<0.01).
Cohort (n=127)
Does 2D speckle-tracking echocardiography predict deterioration of LVEF in asymptomatic patients with aortic regurgitation and preserved LVEF?
Global longitudinal strain assessed by 2D speckle-tracking echocardiography is an independent predictor of LVEF deterioration in asymptomatic patients with severe aortic regurgitation, potentially aiding in the optimal timing of surgery.
Effect estimate: AUC 0.89
p-value: p=<0.01
BACKGROUND: The management of asymptomatic patients with aortic regurgitation (AR) and preserved left ventricular (LV) ejection fraction (LVEF) remains challenging. The purpose of the study was to assess the early changes of LV mechanics by 2D speckle-tracking echocardiography (2D-STE) in order to predict a decrease in LVEF. METHODS: Sixty-seven patients (age, 47 ± 15 years) with asymptomatic moderate (n = 27) and severe AR (n = 40) with preserved LVEF were prospectively followed for about 5 years. Sixty healthy age-matched controls were included in the study. Standard echocardiography and 2D-STE were performed at the baseline and follow-up. The primary endpoint was a deterioration of the LVEF (≤50%). RESULTS: At baseline, global LV longitudinal peak systolic strain (GLS) and strain rate (GLSRs) were decreased in patients with severe AR compared to controls (-18.9 ± 2.4 vs 20.0 ± 2.1%; -1.05 ± 0.19 vs -1.18 ± 0.15 1/s, P < .05, respectively). In the moderate AR group, GLS was not different from that of the control group, but GLSRs was significantly lower than in controls. The primary endpoint was reached in 12 patients with severe AR, while this was not observed in patients with moderate AR. In multivariate analysis, GLS was an independent predictor of LVEF. According to ROC curve analysis, probability of primary endpoint occurrence was significantly greater in patients with GLS values ≥-18.5% (AUC: 0.89, P < .01). CONCLUSIONS: The reduction of LV longitudinal deformation is a sign of early subclinical LV dysfunction. GLS is a prognostic predictor of LV dysfunction and may be potentially useful for optimal timing of surgery for patients with significant AR.
Verseckaitė et al. (Sun,) ont mené une étude de cohorte sur l'insuffisance aortique asymptomatique avec FEVG préservée (n=127). Le strain longitudinal pic systolique global du ventricule gauche (GLS) vs témoins sains / insuffisance aortique modérée a été évalué sur la détérioration de la FEVG (≤50 %) (AUC 0.89, p=<0.01). Des valeurs de strain longitudinal global du ventricule gauche ≥ -18,5 % ont prédit de manière significative la détérioration de la fraction d'éjection ventriculaire gauche dans l'insuffisance aortique asymptomatique (AUC 0.89, P<0.01).
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