Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 9, September, p. 1271–1279

doi: 10.17219/acem/104553

Publication type: review article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Echocardiographic evaluation of left ventricular strain in severe aortic stenosis with therapeutic implications and risk stratification

Anna Teresa Goździk1,A,B,C,D, Marek Jasiński1,C,E,F, Waldemar Goździk2,C,E,F

1 Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Poland

2 Department and Clinic of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland

Abstract

Degenerative aortic stenosis (AS) is an increasingly common acquired valvular heart disease in adults due to the extension of life expectancy in the population of developing countries. The occurrence of calcifications and associated severe aortic stenosis (SAS) increases with age and affects approx. 3–5% of people over 75 years of age. The basis for the decision on the date and type of therapy is echocardiographic evaluation of the severity of the AS and left ventricular (LV) function as well as clinical signs. It appears that the use of newer, more precise methods in echocardiography, especially in patients with preserved ejection fraction (pEF), may change our management in qualifying for valve replacement, especially in asymptomatic patients with SAS. The aim of this review study is echocardiographic strain analysis and evaluation of strain of LV myocardial fibers in patients with SAS, using the speckle tracking echocardiography (STE). This evaluation allows for risk stratification of a valve disease and the choice of the appropriate therapy method.

Key words

aortic stenosis, speckle tracking echocardiography, strain

References (52)

  1. Carabello BA. Introduction to aortic stenosis. Circ Res. 2013;113(2):179–185.
  2. Aggarwal S, Clavel MA, Messika-Zeitoun D, et al. Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis. Circ Cardiovasc Imaging. 2013;6(1):40–47.
  3. Kadem L, Dumessnil JG, Rieu R, Durand LG, Garcia D, Pibarot P. Impact of systemic hypertension on the assessment of aortic stenosis. Heart. 2005;91(3):354–361.
  4. Baumgartner H, Falk V, Bax J, et al; ESC Scientific Document Group. ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;36(38):2739–2791.
  5. Thourani VH, Suri RM, Gunter RL, et al. Contemporary real-world outcomes of surgical valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients. Ann Thorac Surg. 2015;99(1):55–61.
  6. Kurtz CE, Otto CM. Aortic stenosis: Clinical aspects of diagnosis and management with 10 illustrative case reports a 25-year experience. Medicine (Baltimore). 2010;89(6):349–379.
  7. Eveborn GW, Schrimer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis: The Tromsø study. Heart. 2013;99(6):396–400.
  8. Otto CM, Prendergast B. Aortic valve stenosis: From patients at risk to severe valve obstruction. N Engl J Med. 2014;371(8):744–756.
  9. Joint Task Force on Management of valvular heart disease of European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS); Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33(19):2451–2496.
  10. Rosenhek R, Binder T, Porenta G, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343(9):611–617.
  11. Rosenhek R, Zilberszac R, Schemper M, et al. Natural history of very severe aortic stenosis. Circulation. 2010;121(1):151–156.
  12. Otto CM, Burwash IG, Legget ME, et al. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic and exercise predictors of outcome. Circulation. 1997;95(9):2262–2270.
  13. Ross J Jr. Afterload mismatch in aortic and mitral valve disease: Implications for surgical therapy. J Am Coll Cardiol. 1985;5(4):811–826.
  14. Minners J, Allgeier M, Gohlke-Baerwolf C, et al. Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis. Eur Heart J. 2008;29(8):1043–1048.
  15. Baumgartner H, Hung J, Bermejo J, et al. Focus update on the echocardiographic assessment of aortic valve stenosis: EAE/ASE recommendations for clinical practice. Eur Heart J Cardiovasc Imaging. 2017;18(3):254–227.
  16. Monin JL, Quere JP. Low gradient aortic stenosis: Operative risk stratification and predictors for long term outcome. A multicenter study using dobutamine stress hemodynamics. Circulation. 2003;108(3):319–324.
  17. Clavel MA, Dumesnil JG. Outcome of patients with aortic stenosis, small valve area and low flow low gradient despite preserved left ventricular ejection fraction. J Am Coll Cardiol. 2012;60(14):1259–1267.
  18. Clavel MA, Messika-Zeitoun D. The complex nature of discordant severe calcified aortic valve disease grading: New insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol. 2013;62(24):2329–2338.
  19. Takeda S, Rimington H, Smeeton N, Chambers J. Long axis excursion in aortic stenosis. Heart. 2001;86(1):52–56.
  20. Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P. Paradoxical low flow, low gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007;115(22):2856–2864.
  21. Lancellotti P, Donal E, Magne J, et al. Risk stratification in asymptomatic moderate to severe aortic stenosis: The importance of the valvular, arterial and ventricular interplay. Heart. 2010;96(17):1364–1371.
  22. Galema TW, Yap SC, Geleijnse ML, et al. Early detection of left ventricular dysfunction by Doppler tissue imaging and N-terminal pro B-type natriuretic peptide inpatients with symptomatic severe aortic stenosis. J Am Soc Echocardiogr. 2008;21(3):257–261.
  23. Steine K, Rossebø AB, Stugaard M, Pedersen TR. Left ventricular systolic and diastolic function in asymptomatic patients with moderate aortic stenosis. Am J Cardiol. 2008;102(7):897–890.
  24. Stewart RA, Kerr AJ, Whalley GA, et al; New Zealand Heart Valve Study Investigators. Left ventricular systolic and diastolic function assessed by tissue Doppler imaging and outcome in asymptomatic aortic stenosis. Eur Heart J. 2010;31(18):2216–2222.
  25. Geyer H, Caracciolo G, Abe H, et al. Assessment of myocardial mechanics using speckle tracking echocardiography: Fundamentals and clinical applications. J Am Soc Echocardiogr. 2010;23(4):351–369.
  26. Lafitte S, Perlant M, Reant P, et al. Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr. 2009;10(3):414–419.
  27. Cramariuc D, Gerdts E, Davidsen ES, Segadal L, Matre K. Myocardial deformation in aortic valve stenosis: Relation to the left ventricular geometry. Heart. 2010;96(2):106–112.
  28. Ng ACT, Delgado V, Bertini M, et al. Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: A two-dimensional speckle tracking analysis. Eur Heart J. 2011;32(12):1542–1550.
  29. Miyazaki S, Daimon M, Miyazaki T, et al. Global longitudinal strain in relation to the severity of aortic stenosis: A two-dimensional speckle tracking study. Echocardiography. 2011;28(7):703–708.
  30. Delgado V, Tops LF, van Bommel RJ, et al. Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement. Eur Heart J. 2009;30(24):3037–3047.
  31. Galli E, Leguerrier A, Flecher E, Leclercq C, Donal E. Increased valvulo-arterial impedance differently impacts left ventricular longitudinal, circumferential and radial function in patients with aortic stenosis: A speckle tracking echocardiography study. Echocardiography. 2017;34(1):37–43.
  32. Donal E, Bergerot C, Thibault H, et al. Influence of afterload on left ventricular radial and longitudinal systolic functions: A two-dimensional strain imaging study. Eur J Echocardiogr. 2009;10(8):914–921.
  33. Marechaux S, Carpentier E, Six-Carpentier M, et al. Impact of valvuloarterial impedance on left ventricular longitudinal deformation in patients with aortic valve stenosis and preserved ejection fraction. Arch Cardiovasc Dis. 2010;103(4):227–235.
  34. Sengupta PP, Taljik AJ. Twist mechanics of the left ventricle: Principles and application. JACC Cardiovasc Imaging. 2008;1(3):366–376.
  35. Popescu BA, Calin A. Left ventricular torsional dynamics in aortic stenosis: Relationship between left ventricular untwisting and filing pressures. A two-dimensional speckle tracking study. Eur J Echocardiogr. 2010;11(5):406–413.
  36. Voigt JU, Lindenmeier G, Exner B, et al. Incidence and characteristics of segmental post systolic longitudinal shortening in normal, acutely ischemic, and scarred myocardium. J Am Soc Echocardiogr. 2003;16(5):415–423.
  37. Moonen M, Lancellotti P, Zacharakis D, et al. The value of 2D strain imaging during stress testing. Echocardiography. 2009;26(3):307–314.
  38. Donal E, Thebault C, O’Connor K, et al. Impact of aortic stenosis on longitudinal myocardial deformation during exercise. Eur J Echocardiogr. 2011;12(3):235–241.
  39. Marechaux S, Ennezat PV, Lelemtel TH, et al. Left ventricular response to exercise in aortic stenosis: An exercise echocardiographic study. Echocardiography. 2007;24(9):955–959.
  40. Lindqvist P, Zhao Y, Bajraktari G, Holmgren A, Henein MY. Aortic valve replacement normalizes left ventricular twist function. Interact Cardiovasc Thorac Surg. 2011;12(5):701–706.
  41. van Dalen BM, Tzikas A, Soliman OI, et al. Left ventricular twist and untwist in aortic stenosis. Int J Cardiol. 2011;148(3):319–324.
  42. Carasso S, Cohen O, Mutlak D, et al. Relation of myocardial mechanics in severe aortic stenosis to left ventricular ejection fraction and response to aortic valve replacement. Am J Cardiol. 2011;107(7):1052–1057.
  43. Lech AK, Dobrowolski PP, Klisiewicz A, Hoffman P. Exercise-induced changes in left ventricular global longitudinal strain in asymptomatic severe stenosis. Kardiol Pol. 2017;75(2):143–149.
  44. Ng ACT, Prihadi EA, Antoni L, et al. Left ventricular global longitudinal strain is predictive off all-cause mortality independent of aortic stenosis severity and ejection fraction. Eur Heart J Cardiovasc Imaging. 2018;19(8):859–867.
  45. Kusunose K, Goodman A, Parikh R, et al. Incremental prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis and preserved ejection fraction. Circ Cardiovasc Imaging. 2014;7(6):938–945.
  46. Lancellotti P, Magne J, Donal E, et al. Clinical outcome in asymptomatic severe aortic stenosis: Insights from the new proposed aortic stenosis grading classification. J Am Coll Cardiol. 2012;59(3):235–243.
  47. Clavel MA, Webb JG,Rodés-Cabau J, et al. Comparison between transcatheter and surgical prosthetic valve implantation in patients with severe aortic stenosis and reduced left ventricular ejection fraction. Circulation. 2010;122(19):1928–1936.
  48. Rost C, Korder S, Wasmeier G, et al. Sequential changes in myocardial function after valve replacement after aortic valve replacement for aortic stenosis by speckle tracking echocardiography. Eur J Echocardiogr. 2010;11(7):584–589.
  49. Carasso S, Cohen O, Mutlak D, et al. Differential effects of afterload on left ventricular long and short axis function: Insights from a clinical model of patients with aortic valve stenosis undergoing aortic valve replacement. Am Heart J. 2009;158(4):540–545.
  50. Biswas M, Sudhakar S, Nanda NC, et al. Two- and three-dimensional speckle tracking echocardiography: Clinical applications and future directions. Echocardiography. 2013;30(1):88–105.
  51. Dweck MR, Joshi S, Murigu T, et al. Midwall fibrosis is an independent predictor of mortality in patients with aortic stenosis. J Am Coll Cardiol. 2011;58(12):1271–1279.
  52. Barone-Rochette G, Pierard S, De Meester de Ravenstein C, et al. Prognostic significance of LGE by CMR in aortic stenosis patients undergoing valve replacement. J Am Coll Cardiol. 2014;64(2):144–154.