Key result
Severe AS with increased LV wall thickness is linked to lower 3D and 2D GLS.
Why the study?
The capability of RT3DE and 2D MSTE to evaluate early myocardial dysfunction caused by increased LV wall thickness in severe AS with normal LVEF was not established.
Can RT3DE and 2D MSTE identify early myocardial dysfunction in patients with severe aortic stenosis and normal LVEF?
Cross-Sectional
Can RT3DE and 2D MSTE identify early myocardial dysfunction in patients with severe aortic stenosis and normal LVEF?
RT3DE and 2D MSTE can identify subtle contractile dysfunction in severe aortic stenosis patients with normal LVEF, particularly those with increased LV wall thickness.
Supports strain imaging to detect subclinical dysfunction in severe AS with LV hypertrophy and normal LVEF; hypothesis-generating for prognostic or therapeutic implications.
BACKGROUND: The aim of this study was to determine the capability of real time three-dimensional echocardiography (RT3DE) and two-dimensional (2D) multilayer speckle tracking echocardiography (MSTE) for evaluation of early myocardial dysfunction triggered by increased left ventricular (LV) wall thickness in severe aortic stenosis (AS) with normal LV ejection fraction (EF≥55%). METHODS: , aortic velocity Vmax >4 m/s or mean PG >40 mm Hg) and normal left ventricular ejection fraction (LVEF) without overt coronary artery disease and in 18 age-, sex-matched healthy controls. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were calculated using RT3DE and MSTE. RESULTS: The severe AS group had lower 3D GLS, GRS, GAS and 2D epicardium, and mid-wall and endocardium GLS compared to healthy controls. In MSTE analysis, 2D LS and CS values decreased from the endocardial layer toward the epicardial layer. Severe AS patients with increased LV wall thickness had lower 3D GLS and 2D epicardium, and mid-wall and endocardium GLS compared with severe AS patients without LV wall thickening. GLS on RT3D STE was correlated with GLS on 2D MSTE, left ventricular mass index, LVEF, left atrial volume index, and lnNT-proBNP. CONCLUSION: RT3DE and 2D MSTE can be used to identify subtle contractile dysfunction triggered by increased LV wall thickness in severe AS with normal LVEF. Therefore, RT3D STE and 2D MSTE may provide additional information that can facilitate decision-making regarding severe AS patients with increased LV wall thickness and normal LV function.
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Cho et al. (2017) conducted a cross-sectional in Severe aortic stenosis with normal left ventricular ejection fraction. Severe aortic stenosis with increased left ventricular wall thickness vs. Healthy controls and severe AS without LV wall thickening was evaluated on Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS). Severe aortic stenosis with increased left ventricular wall thickness is associated with lower 3D and 2D global longitudinal strain compared to healthy controls and those without wall thickening.
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