Dissecting Myocardial Mechanics in Patients With Severe Aortic Stenosis: 2-Dimensional vs 3-Dimensional–Speckle Tracking Echocardiography
Background: Aortic valve stenosis (AS) commonly causes left ventricular (LV) pressure overload; thus, identifying patients with adverse remodeling/early LV dysfunction is critical. We compared 2-dimensional (2D) to 3-dimensional (3D) echocardiographic measures of LV myocardial deformation in patients with severe AS and studied the relation of LV preload and afterload (Zva) to myocardial deformation.
Methods: We prospectively included 168 symptomatic patients (72±12 years) with severe AS and ejection fractions ≥50%. Strain parameters from those patients were compared with normal values found in the literature. 3D full-volume and 2D images were analyzed for global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), systolic strain rate (SRs), basal rotation (Rotmax-B), apical rotation (Rotmax-A), and peak systolic twist (Twistmax).
Results: 2D–GLS and 2D–GCS decreased significantly compared with normal values (P˂.001 and P=.02, respectively); 2D Rotmax-B and Twistmax increased (P˂.001 vs normal values). Agreement between 2D–GLS and 3D–GLS by concordance correlation coefficient was 0.49 (95% CI, 0.39-0.57) in patients with AS. Both 2D– and 3D–GLS correlated with valvulo-arterial impedance (Zva) (r=0.34, P<.001; and r=0.23, P=.003, respectively).
Conclusion: In patients with severe AS, GLS and GCS decreased, and basal rotation and twist increased to maintain LV ejection fraction. 2D– and 3D–GLS had a relatively fair agreement. Both 2D– and 3D–GLS correlated modestly with Zva.
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On 08 Jan, 2020
On 07 Jan, 2020
On 07 Jan, 2020
On 06 Jan, 2020
Received 28 Dec, 2019
Invitations sent on 09 Dec, 2019
On 09 Dec, 2019
On 09 Dec, 2019
Received 09 Dec, 2019
On 08 Dec, 2019
On 07 Dec, 2019
On 07 Dec, 2019
Posted 10 Sep, 2019
On 28 Sep, 2019
Received 24 Sep, 2019
Received 16 Sep, 2019
On 11 Sep, 2019
Invitations sent on 10 Sep, 2019
On 10 Sep, 2019
On 09 Sep, 2019
On 08 Sep, 2019
On 05 Sep, 2019
Dissecting Myocardial Mechanics in Patients With Severe Aortic Stenosis: 2-Dimensional vs 3-Dimensional–Speckle Tracking Echocardiography
On 08 Jan, 2020
On 07 Jan, 2020
On 07 Jan, 2020
On 06 Jan, 2020
Received 28 Dec, 2019
Invitations sent on 09 Dec, 2019
On 09 Dec, 2019
On 09 Dec, 2019
Received 09 Dec, 2019
On 08 Dec, 2019
On 07 Dec, 2019
On 07 Dec, 2019
Posted 10 Sep, 2019
On 28 Sep, 2019
Received 24 Sep, 2019
Received 16 Sep, 2019
On 11 Sep, 2019
Invitations sent on 10 Sep, 2019
On 10 Sep, 2019
On 09 Sep, 2019
On 08 Sep, 2019
On 05 Sep, 2019
Background: Aortic valve stenosis (AS) commonly causes left ventricular (LV) pressure overload; thus, identifying patients with adverse remodeling/early LV dysfunction is critical. We compared 2-dimensional (2D) to 3-dimensional (3D) echocardiographic measures of LV myocardial deformation in patients with severe AS and studied the relation of LV preload and afterload (Zva) to myocardial deformation.
Methods: We prospectively included 168 symptomatic patients (72±12 years) with severe AS and ejection fractions ≥50%. Strain parameters from those patients were compared with normal values found in the literature. 3D full-volume and 2D images were analyzed for global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), systolic strain rate (SRs), basal rotation (Rotmax-B), apical rotation (Rotmax-A), and peak systolic twist (Twistmax).
Results: 2D–GLS and 2D–GCS decreased significantly compared with normal values (P˂.001 and P=.02, respectively); 2D Rotmax-B and Twistmax increased (P˂.001 vs normal values). Agreement between 2D–GLS and 3D–GLS by concordance correlation coefficient was 0.49 (95% CI, 0.39-0.57) in patients with AS. Both 2D– and 3D–GLS correlated with valvulo-arterial impedance (Zva) (r=0.34, P<.001; and r=0.23, P=.003, respectively).
Conclusion: In patients with severe AS, GLS and GCS decreased, and basal rotation and twist increased to maintain LV ejection fraction. 2D– and 3D–GLS had a relatively fair agreement. Both 2D– and 3D–GLS correlated modestly with Zva.
Figure 1
Figure 2
Figure 3