TY - JOUR
T1 - Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction
T2 - A two-dimensional speckle tracking analysis
AU - Ng, Arnold C.T.
AU - Delgado, Victoria
AU - Bertini, Matteo
AU - Antoni, Marie Louisa
AU - Van Bommel, Rutger J.
AU - Van Rijnsoever, Eva P.M.
AU - Van Der Kley, Frank
AU - Ewe, See Hooi
AU - Witkowski, Tomasz
AU - Auger, Dominique
AU - Nucifora, Gaetano
AU - Schuijf, Joanne D.
AU - Poldermans, Don
AU - Leung, Dominic Y.
AU - Schalij, Martin J.
AU - Bax, Jeroen J.
N1 - Funding Information:
J.J.B. received grants from Biotronik, Medtronic, Boston Scientific Corporation, Bristol-Myers Squibb Medical Imaging, St Jude Medical, GE Healthcare, and Edwards Lifesciences. M.J.S. received grants from Boston Scientific, Medtronic, and Biotronik.
PY - 2011/6
Y1 - 2011/6
N2 - AimsTo identify changes in multidirectional strain and strain rate (SR) in patients with aortic stenosis (AS).Methods and resultsA total of 420 patients (age 66.1 ± 14.5 years, 60.7 men) with aortic sclerosis, mild, moderate, and severe AS with preserved left ventricular (LV) ejection fraction [(EF), <50] were included. Multidirectional strain and SR imaging were performed by two-dimensional speckle tracking. Patients were more likely to be older (P < 0.001) and at a worse New York Heart Association functional class (P < 0.001) with increasing AS severity. There was a progressive stepwise impairment in longitudinal, circumferential, and radial strain and SR with increasing AS severity (all P < 0.001). The myocardial dysfunction appeared to start in the subendocardium with mild AS, to mid-wall dysfunction with moderate AS, and eventually transmural dysfunction with severe AS. Aortic valve area, as a measure of AS severity, was an independent determinant of multidirectional strain and SR on multiple linear regressions.ConclusionsPatients with AS have evidence of subclinical myocardial dysfunction early in the disease process despite normal LVEF. The myocardial dysfunction appeared to start in the subendocardium and progressed to transmural dysfunction with increasing AS severity. Symptomatic moderate and severe AS patients had more impaired multidirectional myocardial functions compared with asymptomatic patients.
AB - AimsTo identify changes in multidirectional strain and strain rate (SR) in patients with aortic stenosis (AS).Methods and resultsA total of 420 patients (age 66.1 ± 14.5 years, 60.7 men) with aortic sclerosis, mild, moderate, and severe AS with preserved left ventricular (LV) ejection fraction [(EF), <50] were included. Multidirectional strain and SR imaging were performed by two-dimensional speckle tracking. Patients were more likely to be older (P < 0.001) and at a worse New York Heart Association functional class (P < 0.001) with increasing AS severity. There was a progressive stepwise impairment in longitudinal, circumferential, and radial strain and SR with increasing AS severity (all P < 0.001). The myocardial dysfunction appeared to start in the subendocardium with mild AS, to mid-wall dysfunction with moderate AS, and eventually transmural dysfunction with severe AS. Aortic valve area, as a measure of AS severity, was an independent determinant of multidirectional strain and SR on multiple linear regressions.ConclusionsPatients with AS have evidence of subclinical myocardial dysfunction early in the disease process despite normal LVEF. The myocardial dysfunction appeared to start in the subendocardium and progressed to transmural dysfunction with increasing AS severity. Symptomatic moderate and severe AS patients had more impaired multidirectional myocardial functions compared with asymptomatic patients.
KW - Aortic stenosis
KW - Aortic valve
KW - Echocardiography
KW - Left ventricle
UR - http://www.scopus.com/inward/record.url?scp=79959396881&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehr084
DO - 10.1093/eurheartj/ehr084
M3 - Article
C2 - 21447510
AN - SCOPUS:79959396881
SN - 0195-668X
VL - 32
SP - 1542
EP - 1550
JO - European heart journal
JF - European heart journal
IS - 12
ER -