In this study we tried to use systolic aortic root motion (M mode)and aortic root motion angle as novel indices of global left ventricular systolic function In the 100 patients included in this study ,there are Significant differences between control groups and patient groups in aortic root motion ( m mode )with t = 20.1 and p value < 0.001 and Significant differences between two groups in aortic root motion angle with t = 16.945 and p value < 0.001.Also there are Significant differences between control groups and patient groups in global long longitudinal Strain with t= -13.19 and p value < 0.001 .
Aortic root motion m mode (cm) and aortic root motion angle have significant positive correlation with EF(Mm), EF(2D), Fs, global longitudinal strain(GLS) and global longitudinal Strain rate .
The best cutoff value of aortic root SAM was 8.5 mm. An aortic root SAM of ˂ 8.5 mm predicts an LVEF of ˂ 50% (by 2D) with sensitivity of 95.9%, specificity of 96.1%. The best cutoff value of aortic root motion angle was 19.5 mm, with sensitivity of 93.9%, specificity of 96.1%.
Regarding correlation between EF and global longitudinal strain, Our finding agrees with study done in 2018 by Luigi et al. He retrospectively identified 96 patients with a reduced LVEF < 50% (screening echocardiogram), whose LVEF had increased by at least 10% and normalized (> 50%) on evidence based medical therapies (baseline echocardiogram). He examined absolute global longitudinal strain (GLS) on the baseline echocardiogram in relation to changes in LVEF on a follow-up echocardiogram; Patients with recovered LVEF had a wide range of GLS. The GLS on the baseline study correlated with the LVEF at the time of follow-up (r = 0.33, p < 0.001). The likelihood of having an LVEF > 50% on follow-up increased by 24% for each point increase in absolute GLS on the baseline study (or 1.24, p = 0.001).An abnormal GLS (≤ 16%) at baseline had a sensitivity of 88%, a specificity of 46%, and an accuracy of 0.67 (p < 0.001) as a predictor of a decrease in LVEF > 5% during follow up. A normal GLS (> 16%) on the baseline study had a sensitivity of 47%, a specificity of 83% and an accuracy of 0.65 (p = 0.002) for predicting a stable LVEF (− 5 to 5%) on follow-up.
He concluded that; in patients with a recovered LVEF, an abnormal GLS predicts the likelihood of having a decrease LVEF during follow-up, whereas a normal GLS predicts the likelihood of stable LVEF during recovery.
Recordings of aortic root movement represent one of the first accomplishments of ultrasound in medicine and mark the beginning of functional cardiac imaging. However, the underlying mechanism is not completely understood (13). Since the aortic root is directly connected to the cardiac skeleton Matthias A et al, 2019 hypothesized, that the amplitude of systolic aortic root motion (SARM) may be mainly caused by displacement of the cardiac base towards the apex and might therefore be used as measure of left ventricular longitudinal function (LV-LF). There study was done on 180 patients with dilated cardiomyopathy and 180 healthy controls were prospectively included into this study. They founded that SARM was lower in patients compared to controls (9 ± 3 mm vs. 12 ± 2 mm, p < 0.001) and lowest in patients with cardiovascular events (9 ± 3 mm vs. 7 ± 3 mm, p < 0.001). During a median follow-up time of 38 months, the combined end-point of cardiovascular death or hospitalization for heart failure was reached by 25 patients (13.9%). Reduced SARM had significant prognostic impact on outcome (hazard ratio 0.74, 95% confidence interval 0.63–0.88, p < 0.001) and remained an independent predictor in the multivariate analysis. Compared to parameters with potential influence on its mechanism, SARM correlated best (r = 0.75, p < 0.001) with global longitudinal strain (GLS). SARM may therefore represent an alternative echocardiographic parameter for the assessment of LV-LF, particularly when GLs is not feasible or apical views are not available. Due to its high echogenicy, SARM can easily be visualized by M-mode echocardiography. Matthias A et al, 2019 demonstrated that SARM is not exclusively directed anterior but shows an additional downward and lateral-left displacement similar to the systolic movement of the cardiac base towards the apex, Abnormal SARM is a frequent finding in cardiac disease. Alterations are, however, not specific to a particular pathology but can generally be regarded as a prognostically unfavorable sign in patients with systolic heart failure, Matthias A et al, 2019 data suggest that SARM is closely related to global longitudinal strain and thus might represent an alternative measure of LV longitudinal function especially when strain assessment is not feasible or available.
In our study we founded that SARM was lower in patients compared to controls (5.8 ± 1.17 mm, 5.44 ± 1.19 in patients group 3 and 4 vs. 11.9 ± 2.2, 12.8 ± 2.1 mm, p < 0.001 in controls group). Our findings agree with Matthias A et al, 2019 and demonstrates the difference between patient Groups in Values of Root Motion m mode height which specify a Statistically significant higher value in healthy group (1 and 2) than patient in group (3 and 4) where EF 2d less than 50% .SARM correlated best (r = 0.814, p < 0.001) with global longitudinal strain (GLS) which also agrees with Matthias A et al, 2019.
Another study done by Ahmadou M et al, 2018 on correlations of left ventricular systolic function indices with aortic root systolic excursion (ARSE) in which Overall 213 echocardiograms were included from 106 males (49.8%), with mean age of the participants being 52.4 (SD: 18.3) years. The rate of LV systolic dysfunction was highest with Teicholz method (17.4%) and lowest with MAPSE method (5.2%). ARSE correlated with the LV functions. This was highest for the Simpson method (r = 0.619, p < 0.001), and lowest for the ITV method (r = 0.319, p < 0.001). Optimal cut-offs to detect LV systolic dysfunction was ≈ 6.6 mm. For an LV ejection fraction < 55%, the sensitivity was 82.9%, and the specificity was 97.2%, demonstrated that ARSE correlated well with LV systolic function which agrees with our finding as we founded that aortic root motion m mode diameter has a significant correlation with EF_Mm, EF-2D, Fs, SV, Global longitudinal strain and strain rate.
Our findings agree also with Osama A Diab,2015 who study the quantitative assessment of Aortic Root Systolic Anterior Motion as an echocardiographic measure of global left ventricular systolic function.
The study included 38 males and 19 females with mean age of 49.8 ± 16.4 years. Mean aortic root SAM was 9.3 ± 2.8 mm (range: 2–15 mm). Mean M-mode derived LVEF was 49.3 ± 17.9%, and 2D derived LVEF was 46.2 ± 16.9%. Mean FS was 28.2 ± 12.5%. Mean Aortic cusp separation (ACS) was 16.8 ± 3.3 mm. In 15 patients (26.3%) there was SWMA, while the remaining 42 patients (73.7%) had normal segmental wall motions. Aortic root SAM was strongly correlated with LVEF by M-mode (r = 0.77, p = 0.00), LVEF by 2D (r = 0.78, p = 0.00), FS (r = 0.79, p = 0.00), and ACS (r = 0.56, p = 0.00). These correlations were better in patients with normal wall motions than those with SWMA. Diab O.A. 2015 found that the best cutoff value of aortic root SAM was 9.5 mm. An aortic root SAM of ˂ 9.5 mm predicts an LVEF of ˂ 50% (by 2D) with sensitivity of 92%, specificity of 96.7%, and total validity of 94.5%.
To the best of our knowledge It is the first time to study Aortic Root Motion angle correlation to left ventricular systolic function indices and we founded that Aortic Root Motion angle has a significant correlation with EF_(M mode, EF-2D), Fs and global (GLS) Strain and strain rate.
We founded that Aortic Root Motion angle was lower in patients compared to controls (9.9 ± 4.4, 6.5 ± 2.9) in patients groups 3and 4 vs.( 22.9 ± 3.6, 23.6 ± 2.9) in control groups 1and 2) .
Study of ROC curve of Root Motion m mode diameter, Aortic Root Motion angle and global (LSGG) Strain yield that the Cut-off value of Root Motion m mode diameter was 8.5 mm with specificity 96.1% and sensitivity 95.9%, the Cut-off value of Aortic Root Motion angle was 19.5 mm with specificity 96.1% and sensitivity 93.9% and the Cut-off value of global (LSGG) Strain was 13.25 mm with specificity 88% and sensitivity 89.8%.