TY - JOUR
T1 - Left ventricular myocardial deformation as measure of hemodynamic burden in congenital valvular aortic stenosis
AU - Reddy, S. Chandra Bose
AU - Zhang, Jin
AU - Jani, Vivek
AU - Wolfe, Steven B.
AU - Danford, David
AU - Kutty, Shelby
AU - Pignatelli, Ricardo H.
N1 - Funding Information:
This work was supported by the Cardiovascular Clinical Research Core at Baylor College of Medicine , Texas Children's Hospital, Houston, Texas. We acknowledge sonographers Monica Martin, RDCS, and Douglas K. Feagin, Jr., RDCS for their assistance in studies and storage of raw data.
Funding Information:
This work was supported by the Cardiovascular Clinical Research Core at Baylor College of Medicine, Texas Children's Hospital, Houston, Texas. We acknowledge sonographers Monica Martin, RDCS, and Douglas K. Feagin, Jr. RDCS for their assistance in studies and storage of raw data.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Background: Changes in 2D echocardiography (2DE) speckle tracking imaging (STI) derived left ventricular (LV) strain (S) and strain rate (SR) precedes diminution of LV ejection fraction (LVEF) in adult valvular aortic stenosis (AS). We prospectively examined whether 2DE-STI derived multidirectional LV S and SR correlate with AS severity in children using LV mass index (MI) as the principal outcome variable. Methods: 52 children (10.4 ± 7.3 years) with isolated congenital AS were included; 13 mild (2.5 m/s < Vmax < 3.0 m/s), 25 moderate (3.0 m/s < Vmax < 4.0 m/s), and 14 severe (Vmax > 4.0 m/s). 2DE including Doppler and STI longitudinal strain (LS), strain rate (LSR), circumferential strain (CS), and strain rate (CSR) were measured. Univariate and multivariable linear regressions identified correlations between LVMI and strain indices. Results: Three clinical and 2DE variables, and four strain indices were independently associated with LVMI. LVMI correlated positively with systolic blood pressure and aortic regurgitation, and negatively with LVEF. LVMI correlated positively with LSR (four-chamber) and CSR (basal), and negatively with segmental CS in the inferior (basal) and anteroseptal (distal) segments. LVMI showed significant inverse association with LS (P = .05), LSR (P < .001), CS (P < .005), and CSR (P < .0001), independent of AS severity. Conclusions: Independent of clinical and 2DE findings including contemporaneous Doppler estimates of AS gradient, both longitudinal and circumferential strain indices correlate with LVMI as a measure of cumulative hemodynamic burden. This association implies subclinical LV dysfunction.
AB - Background: Changes in 2D echocardiography (2DE) speckle tracking imaging (STI) derived left ventricular (LV) strain (S) and strain rate (SR) precedes diminution of LV ejection fraction (LVEF) in adult valvular aortic stenosis (AS). We prospectively examined whether 2DE-STI derived multidirectional LV S and SR correlate with AS severity in children using LV mass index (MI) as the principal outcome variable. Methods: 52 children (10.4 ± 7.3 years) with isolated congenital AS were included; 13 mild (2.5 m/s < Vmax < 3.0 m/s), 25 moderate (3.0 m/s < Vmax < 4.0 m/s), and 14 severe (Vmax > 4.0 m/s). 2DE including Doppler and STI longitudinal strain (LS), strain rate (LSR), circumferential strain (CS), and strain rate (CSR) were measured. Univariate and multivariable linear regressions identified correlations between LVMI and strain indices. Results: Three clinical and 2DE variables, and four strain indices were independently associated with LVMI. LVMI correlated positively with systolic blood pressure and aortic regurgitation, and negatively with LVEF. LVMI correlated positively with LSR (four-chamber) and CSR (basal), and negatively with segmental CS in the inferior (basal) and anteroseptal (distal) segments. LVMI showed significant inverse association with LS (P = .05), LSR (P < .001), CS (P < .005), and CSR (P < .0001), independent of AS severity. Conclusions: Independent of clinical and 2DE findings including contemporaneous Doppler estimates of AS gradient, both longitudinal and circumferential strain indices correlate with LVMI as a measure of cumulative hemodynamic burden. This association implies subclinical LV dysfunction.
KW - Aortic stenosis
KW - Left ventricular mass index
KW - Myocardial strain
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U2 - 10.1016/j.ijcard.2020.07.008
DO - 10.1016/j.ijcard.2020.07.008
M3 - Article
C2 - 32679139
AN - SCOPUS:85088312209
SN - 0167-5273
VL - 320
SP - 133
EP - 138
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -