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Research article
Hector R. Villarraga
Mayo Clinic Minnesota
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3675-6948
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Background: Aortic stenosis (AS) causes left ventricular (LV) pressure overload, leading to adverse LV remodeling and dysfunction. We examined the impact of severe AS and its consequent increase in LV afterload on myocardial deformation and rotational mechanics by 2-dimensional (2D) and 3-dimensional (3D) speckle-tracking echocardiography. Methods: We prospectively measured various strain parameters in 168 patients (42% female, mean age 72±12 years) with severe AS and LV ejection fraction (EF) ≥50%, and compared them to normal values found in literature. 2D and 3D images were analyzed for global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), basal rotation, apical rotation, and peak systolic twist. We further assessed the degree of concordance between 2D and 3D strain, and examined their association with measures of LV preload and afterload. Results: Patients with severe AS exhibited significantly lower GLS and GRS but higher GCS, apical rotation, and twist by 2D and 3D echocardiography compared with published normal values (P=0.003 for 3D twist,P<0.001 for all others). There was modest agreement between 2D and 3D GLS measurements (concordance correlation coefficient 0.49, 95% confidence interval 0.39-0.57). GLS was modestly correlated with valvulo-arterial impedance, a measure of LV afterload (r=0.34, p<0.001 for 2D and r=0.23, p=0.003 for 3D). Conclusion: Patients with severe AS demonstrate lower-than-normal GLS and GRS as a result of increased afterload but appear to compensate with higher-than-normal GCS, apical rotation, and twist in order to maintain a preserved LVEF. Our study provides, to our knowledge, the most comprehensive analysis to date of myocardial deformation and rotational mechanics by 2D and 3D speckle-tracking echocardiography in patients with severe AS and preserved LVEF.
Keywords
aortic stenosis, speckle-tracking echocardiography, strain, myocardial mechanics.
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CURRENT STATUS: Published
View the published article at BMC Cardiovascular Disorders.
No community comments so far
Editorial decision: Accept
On 09 Jan, 2020
Editor assigned
On 08 Jan, 2020
Submission checks complete
On 07 Jan, 2020
Editor invited
On 07 Jan, 2020
Version 2
Posted 12 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 06 Jan, 2020
Review #2 received
Received 28 Dec, 2019
Reviewers invited
Invitations sent on 09 Dec, 2019
Reviewer #1 agreed
On 09 Dec, 2019
Reviewer #2 agreed
On 09 Dec, 2019
Review #1 received
Received 09 Dec, 2019
Editor assigned
On 08 Dec, 2019
Submission checks complete
On 07 Dec, 2019
Editor invited
On 07 Dec, 2019
No comments provided
Editorial decision: Major revision
On 28 Sep, 2019
Review #1 received
Received 24 Sep, 2019
Review #2 received
Received 16 Sep, 2019
Reviewer #2 agreed
On 11 Sep, 2019
Reviewers invited
Invitations sent on 10 Sep, 2019
Reviewer #1 agreed
On 10 Sep, 2019
Editor assigned
On 09 Sep, 2019
Submission checks complete
On 08 Sep, 2019
Editor invited
On 05 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiac & Cardiovascular Systems
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See the published version of this preprint at BMC Cardiovascular Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Hector R. Villarraga
Mayo Clinic Minnesota
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3675-6948
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Cardiovascular Disorders.
No community comments so far
Editorial decision: Accept
On 09 Jan, 2020
Editor assigned
On 08 Jan, 2020
Submission checks complete
On 07 Jan, 2020
Editor invited
On 07 Jan, 2020
Version 2
Posted 12 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 06 Jan, 2020
Review #2 received
Received 28 Dec, 2019
Reviewers invited
Invitations sent on 09 Dec, 2019
Reviewer #1 agreed
On 09 Dec, 2019
Reviewer #2 agreed
On 09 Dec, 2019
Review #1 received
Received 09 Dec, 2019
Editor assigned
On 08 Dec, 2019
Submission checks complete
On 07 Dec, 2019
Editor invited
On 07 Dec, 2019
No comments provided
Editorial decision: Major revision
On 28 Sep, 2019
Review #1 received
Received 24 Sep, 2019
Review #2 received
Received 16 Sep, 2019
Reviewer #2 agreed
On 11 Sep, 2019
Reviewers invited
Invitations sent on 10 Sep, 2019
Reviewer #1 agreed
On 10 Sep, 2019
Editor assigned
On 09 Sep, 2019
Submission checks complete
On 08 Sep, 2019
Editor invited
On 05 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiac & Cardiovascular Systems
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Cardiovascular Disorders.
Background: Aortic stenosis (AS) causes left ventricular (LV) pressure overload, leading to adverse LV remodeling and dysfunction. We examined the impact of severe AS and its consequent increase in LV afterload on myocardial deformation and rotational mechanics by 2-dimensional (2D) and 3-dimensional (3D) speckle-tracking echocardiography. Methods: We prospectively measured various strain parameters in 168 patients (42% female, mean age 72±12 years) with severe AS and LV ejection fraction (EF) ≥50%, and compared them to normal values found in literature. 2D and 3D images were analyzed for global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), basal rotation, apical rotation, and peak systolic twist. We further assessed the degree of concordance between 2D and 3D strain, and examined their association with measures of LV preload and afterload. Results: Patients with severe AS exhibited significantly lower GLS and GRS but higher GCS, apical rotation, and twist by 2D and 3D echocardiography compared with published normal values (P=0.003 for 3D twist,P<0.001 for all others). There was modest agreement between 2D and 3D GLS measurements (concordance correlation coefficient 0.49, 95% confidence interval 0.39-0.57). GLS was modestly correlated with valvulo-arterial impedance, a measure of LV afterload (r=0.34, p<0.001 for 2D and r=0.23, p=0.003 for 3D). Conclusion: Patients with severe AS demonstrate lower-than-normal GLS and GRS as a result of increased afterload but appear to compensate with higher-than-normal GCS, apical rotation, and twist in order to maintain a preserved LVEF. Our study provides, to our knowledge, the most comprehensive analysis to date of myocardial deformation and rotational mechanics by 2D and 3D speckle-tracking echocardiography in patients with severe AS and preserved LVEF.
Figure 1
Figure 2
Figure 3
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