Key result
AVR linked to improved LV longitudinal strain in severe AS with preserved LVEF.
Why the study?
The myocardial multidirectional strain and strain rate in severe aortic stenosis patients with preserved LVEF and the long-term effect of aortic valve replacement on these parameters were not well characterized.
Does aortic valve replacement improve myocardial multidirectional strain and strain rate in patients with severe aortic stenosis and preserved LVEF?
Observational (n=113)
Does aortic valve replacement improve myocardial multidirectional strain and strain rate in patients with severe aortic stenosis and preserved LVEF?
p-value: p=<0.0001
In patients with severe aortic stenosis and preserved LVEF, impaired multidirectional strain and strain rate can be detected by 2D speckle-tracking imaging and significantly improve 17 months after surgical aortic valve replacement.
Strain recovery after AVR in preserved-LVEF AS is detectable by speckle tracking; leaves open whether strain should influence intervention timing.
AIMS: To evaluate myocardial multidirectional strain and strain rate (S-and-SR) in severe aortic stenosis (AS) patients with preserved left ventricular (LV) ejection fraction (EF), using two-dimensional speckle-tracking strain imaging (2D-STI). The long-term effect of aortic valve replacement (AVR) on S-and-SR was also evaluated. METHODS AND RESULTS: Changes in LV radial, circumferential, and longitudinal S-and-SR were evaluated in 73 severe AS patients (65 +/- 13 years; aortic valve area 0.8 +/- 0.2 cm2) with preserved LVEF (61 +/- 11%), before and 17 months after AVR. Strain and strain rate data were compared with data from 40 controls (20 healthy individuals and 20 patients with LV hypertrophy) matched by age, gender, body surface area, and LVEF. Compared with controls, severe AS patients had significantly decreased values of LV S-and-SR in the radial (33.1 +/- 14.8%, P = 0.2; 1.7 +/- 0.5 s(-1), P = 0.003), circumferential (-15.2 +/- 5.0%, P = 0.001; -0.9 +/- 0.3 s(-1), P < 0.0001), and longitudinal (-14.6 +/- 4.1%, P < 0.0001; -0.8 +/- 0.2 s(-1), P < 0.0001) directions. At 17 months after AVR, LV S-and-SR significantly improved in all the three directions, whereas LVEF remained unchanged (60 +/- 12%, P = 0.7). CONCLUSION: In severe AS patients, impaired LV S-and-SR existed although LVEF was preserved. After AVR, a significant S-and-SR improvement in all the three directions was observed. These subtle changes in LV contractility can be detected by 2D-STI.
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Delgado et al. (2009) conducted an observational in Severe aortic stenosis with preserved left ventricular ejection fraction (n=113). Severe aortic stenosis and aortic valve replacement vs. Matched controls and baseline pre-AVR was evaluated on Left ventricular longitudinal strain (p=<0.0001). Severe aortic stenosis with preserved LVEF was associated with significantly impaired LV longitudinal strain (-14.6%, P<0.0001 vs controls), which improved 17 months after aortic valve replacement.
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