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Dissecting myocardial mechanics in patients with severe aortic stenosis: 2-dimensional vs 3-dimensional-speckle tracking echocardiography
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. Identifying early subclinical markers of LV dysfunction in patients with significant AS is critical as this could provide support for earlier intervention, which may result in improved long-term outcomes. We therefore 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). Agreement between 2D- and 3D-GLS by concordance correlation coefficient was 0.49 (95% confidence interval: 0.39-0.57). GLS was correlated with valvulo-arterial impedance, a measure of LV afterload (r=0.34, p<0.001 and r=0.23, p=0.003, respectively).
Conclusion: Patients with severe AS demonstrated lower-than-normal GLS and GRS but appear to compensate with higher-than-normal GCS, apical rotation, and twist in order to maintain a preserved LVEF. GLS showed a modest correlation with valvulo-arterial impedance.
Keywords
aortic stenosis, speckle-tracking echocardiography, strain, myocardial mechanics.
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On 06 Jan, 2020
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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
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Subject Areas
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This preprint is under consideration at BMC Cardiovascular Disorders. A preprint is 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
Dissecting myocardial mechanics in patients with severe aortic stenosis: 2-dimensional vs 3-dimensional-speckle tracking echocardiography
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: Under Review
Version 3
Posted 10 Jan, 2020
No community comments so far
Editor assigned
On 08 Jan, 2020
Submission checks complete
On 07 Jan, 2020
Editor invited
On 07 Jan, 2020
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
Background: Aortic stenosis (AS) causes left ventricular (LV) pressure overload, leading to adverse LV remodeling and dysfunction. Identifying early subclinical markers of LV dysfunction in patients with significant AS is critical as this could provide support for earlier intervention, which may result in improved long-term outcomes. We therefore 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). Agreement between 2D- and 3D-GLS by concordance correlation coefficient was 0.49 (95% confidence interval: 0.39-0.57). GLS was correlated with valvulo-arterial impedance, a measure of LV afterload (r=0.34, p<0.001 and r=0.23, p=0.003, respectively).
Conclusion: Patients with severe AS demonstrated lower-than-normal GLS and GRS but appear to compensate with higher-than-normal GCS, apical rotation, and twist in order to maintain a preserved LVEF. GLS showed a modest correlation with valvulo-arterial impedance.
Figure 1
Figure 2
Figure 3