Subclinical Myocardial Deformation Abnormalities in Asymptomatic Patients with Moderate to Severe Aortic Regurgitation: A Combined Tissue Doppler and Strain Rate Imaging Study

Background: Early detection of myocardial contractility disturbances in patients with asymptomatic moderate to severe aortic regurgitation (AR) leads to the early operative intervention early enough to prevent from poor postoperative heart failure (HF) prognosis. Objective: Our aim was to study the subclinical left ventricular (LV) dysfunction, by novel echocardiographic methods, myocardial deformation indices in patients with asymptomatic, and significant aortic regurgitation (AR). Patients and Methods: Standard echocardiogram and complementary tissue Doppler imaging (TDI) and Doppler based strain and strain rate (S/SR) imaging were performed in 44 asymptomatic patients with pure and significant AR and ejection fraction (EF) more than 50% (mean age:49.9 ± 17.2 years, 50% male) and 20 healthy participants (mean age: 47.3 ± 13.8 years, 65% male). In addition to TDI velocities to investigate the LV longitudinal deformation, peak systolic S and SR were measured at septal, lateral and posterior walls. The LV modified myocardial performance index (MPI) or Tie index also were calculated via TDI study. Results: AR group had significantly increased LV end systolic and end diastolic volumes, interventricular septum and posterior wall thickness compared to controls. In AR, Sm and Em of septal wall, Sm of lateral wall; S and SR of both septal and lateral walls were significantly decreased while MPI were significantly increased compared to healthy participants. Conclusions: Our results demonstrated the ability of PW-TDI and S/SR modalities in detection of the early subclinical abnormalities in asymptomatic patients with significant chronic AR.