Impact of surgical aortic valve replacement on global and regional longitudinal strain across four flow gradient patterns of severe aortic stenosis
- 19 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in The International Journal of Cardiovascular Imaging
- Vol. 37 (7), 2175-2187
- https://doi.org/10.1007/s10554-021-02187-2
Abstract
To evaluate the impact of surgical aortic valve replacement (SAVR) on global (GLS) and regional longitudinal strain (RLS) across four flow-gradient patterns of severe aortic stenosis (AS) 3 months after surgery. A total of 103 patients with severe AS (aortic valve area < 1.0 cm2) were examined by speckle tracking echocardiography the day before SAVR and at 3-months follow-up. Patients were stratified into four flow-gradient patterns by stroke volume index (>35 mL/m2 vs. ≤35 mL/m2) and mean transaortic gradients (>40 mmhg vs. ≤40 mmhg): normal-flow, high gradient (NF/HG); low-flow, high gradient (LF/HG); normal-flow, low gradient (NF/LG); low-flow, low gradient (LF/LG). Strain analysis comprised GLS and RLS at a basal (BLS), mid-ventricular (MLS) and apical level (ALS). Patients with high gradients improved GLS (NF/HG: 16.1 ± 3.5 % vs. 17.3 ± 3.4 %, p = 0.03 and LF/HG: 15.4 ± 3.6 % vs. 16.9 ± 3.1 %, p = 0.03), BLS (NF/HG: 12.7 ± 3.1 % vs. 14.2 ± 3.1 %, p = 0.003 and LF/HG: 11.4 ± 3.2 % vs. 13.8 ± 2.7 %, p = 0.005) and MLS (NF/HG: 15.4 ± 3.3 % vs. 16.5 ± 3.3 %, p = 0.04 and LF/HG: 14.5 ± 3.1 % vs. 16.2 ± 2.7 %, p = 0.01) whereas patients with low gradients showed no improvements three months after SAVR. ALS did not change significantly in any group. Patients with high gradients demonstrated a reduction in left ventricular (LV) mass index (p < 0.001) and N-terminal pro-Brain Natriuretic Peptide levels (p < 0.001) following SAVR in contrast to patients with low gradients. Patients with high gradient severe AS improve GLS and RLS three months after SAVR with concomitant reduction of LV mass and neurohormonal activation whereas patients with low gradients do not improve longitudinal strain, LV mass or neurohormonal activation.This publication has 37 references indexed in Scilit:
- Recovery of left ventricular and left atrial mechanics in various entities of aortic stenosis 12 months after TAVIEuropean Heart Journal – Cardiovascular Imaging, 2013
- Global Strain in Severe Aortic Valve StenosisCirculation: Cardiovascular Imaging, 2012
- Low-Flow, Low-Gradient Severe Aortic Stenosis Despite Normal Ejection Fraction Is Associated With Severe Left Ventricular Dysfunction as Assessed by Speckle-Tracking EchocardiographyCirculation: Cardiovascular Imaging, 2012
- Relation of Myocardial Mechanics in Severe Aortic Stenosis to Left Ventricular Ejection Fraction and Response to Aortic Valve ReplacementThe American Journal of Cardiology, 2011
- Impact of Aortic Valve Stenosis on Left Atrial Phasic FunctionThe American Journal of Cardiology, 2010
- Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic StenosisThe American Journal of Cardiology, 2010
- Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatmentEuropean Heart Journal, 2009
- Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacementEuropean Heart Journal, 2009
- Reduced Systemic Arterial Compliance Impacts Significantly on Left Ventricular Afterload and Function in Aortic Stenosis: Implications for Diagnosis and TreatmentJournal of the American College of Cardiology, 2005
- Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findingsThe American Journal of Cardiology, 1986