European Journal of Echocardiography Advance Access originally published online on November 7, 2008
European Journal of Echocardiography 2009 10(3):414-419; doi:10.1093/ejechocard/jen299
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis
1 Cardiologic Hospital, Pessac and Bordeaux 2 University, France
2 Sacre Coeur Hospital, University of Montreal, Montreal, Canada
3 Division of Cardiology, University of California at San Diego, USA
Received 16 July 2008; accepted after revision 10 October 2008; online publish-ahead-of-print 7 November 2008.
* Corresponding author: Service des Echocardiographies, Hôpital Cardiologique Haut-Lévêque, Avenue Magellan, Pessac 33600, France. Tel: +33 5 57656565 ext. 56430. E-mail address: stephane.lafitte{at}chu-bordeaux.fr
 |
Abstract |
|---|
Aims: As assessed by tissue Doppler velocities, longitudinal contraction is commonly altered at an earlier stage than radial contraction in patients with severe aortic stenosis (AS). However, its relationship to exercise tolerance or to prognosis has not been clearly established. By using two-dimensional (2D) echocardiographic strain, we sought to evaluate values of deformation components in the setting of severe AS and to correlate these values with exercise tolerance and with patients' outcome.
Methods and results: Sixty-five asymptomatic patients with severe AS (aortic valve area <1 cm2) were studied by echocardiography and exercise treadmill and were compared with controls. Conventional echographic parameters as well as longitudinal, radial, and circumferential deformations by 2D strain were measured at rest. During exercise treadmill, maximum tolerated workload, maximum heart rate, blood pressure, and EKG ST variations were recorded. Patients were then followed during 12 months. Compared with controls, despite similar ejection fractions, AS patients presented with a significantly lower global longitudinal strain (GLS) (–17.8 ± 3.5 vs. –21.1 ± 1.8%, P < 0.05) more pronounced in the basal segments (BLS) (–12.4 ± 2.9 vs. –18.4 ± 2.5%, P < 0.05). No difference was observed in terms of radial or circumferential strains. In a subgroup of AS patients with abnormal response to exercise, GLS and BLS were significantly lower (–14.7 ± 5.1 vs. –19.3 ± 4.0% and –10.7 ± 2.5 vs. –14.4 ± 2.1%, P < 0.05). With cut-offs of –18 and –13%, GLS and BLS were able to determine an inadequate exercise response with a sensitivity and specificity of 68 and 75% (AUC 0.77), and 77 and 83% (AUC 0.81), respectively. Finally, patients with a basal strain below –13% presented with more cardiac events in the follow-up.
Conclusion: In asymptomatic patients with severe AS, impaired longitudinal contraction assessed by 2D strain is associated with abnormal exercise response and with an increased risk of cardiac events during follow-up.
Keywords: Aortic valvular stenosis; Myocardial contractility; Strain echocardiography; Prognosis
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. Pibarot and J. G Dumesnil Longitudinal myocardial shortening in aortic stenosis: ready for prime time after 30 years of research? Heart, January 15, 2010; 96(2): 95 - 96. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Lafitte Do we need new echocardiographic prognosticators for the management of heart failure patients? J. Am. Coll. Cardiol., August 11, 2009; 54(7): 625 - 627. [Full Text] [PDF]
|
|