Key result
Layer-specific myocardial strain values were highest in mitral regurgitation and lowest in aortic stenosis compared to healthy individuals (P < .001).
Why the study?
Do layer-specific myocardial strain patterns differ between severe aortic stenosis, primary mitral regurgitation, and healthy individuals, and do they correlate with invasive hemodynamics?
Cross-Sectional
Do layer-specific myocardial strain patterns differ between severe aortic stenosis, primary mitral regurgitation, and healthy individuals, and do they correlate with invasive hemodynamics?
p-value: p=<.001
Layer-specific myocardial strain patterns differ between volume and pressure overload states and correlate with LV wall stress but not contractility in patients with normal LVEF.
May distinguish pressure from volume overload via layer-specific strain in preserved LVEF; hypothesis-generating for wall-stress assessment but requires prospective validation.
AIM: Speckle tracking echocardiography is considered valuable in assessing left ventricular (LV) function. The method has been refined to assess deformation in different myocardial layers, but the effect of volume vs pressure overload on this pattern is unknown. The aim was to test whether layer-specific myocardial strain (LSS) obtained by speckle tracking echocardiography exhibits different patterns in conditions with different loading conditions. METHODS AND RESULTS: , LVEF 70% ± 7%), and 23 healthy individuals (LVEF 65% ± 6%) were enrolled. Echocardiography and right heart catheterization were performed in all patients. In MR, strain values in each myocardial layer (endocardial/global longitudinal strain (GLS)/epicardial) were higher (25.0% ± 3.4%/21.6% ± 2.9%/18.8% ± 2.6%) compared to healthy individuals (22.6% ± 3.2%/19.6% ± 2.9%/17.1% ± 2.6%) and AS (20.5% ± 2.8%/17.7% ± 2.5%/14.0% ± 5.6%), P < .001. All 3 groups exhibited a similar LSS pattern with highest values in the endocardial and lowest values in the epicardial layer. The epicardial-endocardial strain ratio was lower in AS (0.72 ± 0.04) than in MR (0.75 ± 0.04, P = .04). Global longitudinal strain (GLS) correlated significantly with LV wall stress (r = .39, P = .0003) but not with LV stroke work or contractility. CONCLUSION: Layer-specific myocardial strain (LSS) patterns differed in patients with severe AS, significant MR, and healthy individuals with highest values in MR. Strain irrespective of layer assessed was associated with LV wall stress but seemed less related to contractility and unrelated to stroke work in the setting of normal LVEF.
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Bakkestrøm et al. (2018) conducted a cross-sectional in Severe aortic valve stenosis and primary mitral valve regurgitation. Severe aortic valve stenosis and primary mitral valve regurgitation vs. Healthy individuals was evaluated on Layer-specific myocardial strain (endocardial/global longitudinal strain/epicardial) (p=<.001). Layer-specific myocardial strain values were highest in mitral regurgitation and lowest in aortic stenosis compared to healthy individuals (P < .001).
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