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European Journal of Echocardiography Advance Access published online on June 25, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen185
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Myocardial deformation abnormalities in patients with aortic regurgitation: a strain rate imaging study

Anna Marciniak1, George R. Sutherland1, Maciej Marciniak1, Piet Claus2, Bart Bijnens1,2 and Marjan Jahangiri1,*

1 Department of Cardiology and Cardiothoracic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK
2 KULeuven, Leuven, Belgium

Received 24 January 2008; accepted after revision 25 May 2008.

* Corresponding author. Tel: +44 208 725 3565; fax: +44 208 725 2049. E-mail address: marjan.jahangiri{at}stgeorges.nhs.uk


  Abstract

Aims: Early left ventricular (LV) dysfunction in asymptomatic patients with severe aortic regurgitation (AR) may go undetected due to the lack of a sufficiently sensitive diagnostic tool. Ultrasonic strain/strain rate (S/SR) imaging should now provide such sensitivity in detecting early dysfunction in regional LV systolic deformation. The aim of this study was to understand and define the changes in LV regional systolic deformation based on S/SR imaging in patients with asymptomatic or minimally symptomatic AR.

Methods and results: Eighty-one individuals were studied: 59 asymptomatic patients with isolated non-ischaemic AR who were divided into three sub-groups such as mild, moderate, and severe AR and 22 age-matched healthy subjects. All patients underwent standard echocardiographic examinations including a tissue Doppler imaging study. For LV radial deformation, the posterior wall (LVPW) was examined. To assess LV longitudinal deformation, S and SR data were acquired from the LV lateral wall and septum. Radial as well as longitudinal peak systolic SRs were significantly decreased in patients with both moderate AR (LVPW, P = 0.0009; septum, P = 0.03; LV lateral wall, P = 0.0009) and severe AR (P < 0.0001) compared with healthy subjects. Changes in regional LV deformation correlated inversely both with LV end-diastolic volume and with end-systolic volume.

Conclusions: Strain rate imaging is a sensitive tool in detecting the spectrum of changes in radial and longitudinal deformation in asymptomatic or minimally symptomatic patients with AR. The index where volume was corrected by deformation should form the basis for predicting subclinical LV dysfunction in patients with increasing LV dilatation.

Keywords: Aortic regurgitation; Echocardiography; Strain and strain rate imaging


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