Longitudinal strain predicts left ventricular mass regression after aortic valve replacement for severe aortic stenosis
- PDF / 391,060 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 89 Downloads / 195 Views
ORIGINAL ARTICLE
Longitudinal strain predicts left ventricular mass regression after aortic valve replacement for severe aortic stenosis and preserved left ventricular function Sandro Gelsomino • Fabiana Luca` • Orlando Parise • Roberto Lorusso • Carmelo Massimiliano Rao • Enrico Vizzardi • Gian Franco Gensini • Jos G. Maessen
Received: 31 May 2012 / Accepted: 2 November 2012 / Published online: 21 November 2012 Ó Springer Japan 2012
Abstract We explored the influence of global longitudinal strain (GLS) measured with two-dimensional speckletracking echocardiography on left ventricular mass regression (LVMR) in patients with pure aortic stenosis (AS) and normal left ventricular function undergoing aortic valve replacement (AVR). The study population included 83 patients with severe AS (aortic valve area \1 cm2) treated with AVR. Bioprostheses were implanted in 58 patients (69.8 %), and the 25 remaining patients (30.2 %) received mechanical prostheses. Peak systolic longitudinal strain was measured in four-chamber (PLS4ch), twochamber (PLS2ch), and three-chamber (PLS3ch) views, and global longitudinal strain was obtained by averaging the peak systolic values of the 18 segments. Median follow-up was 66.6 months (interquartile range 49.7–86.3 months). At follow-up, values of PLS4ch, PLS2ch, PLS3ch, and GLS were significantly lower (less negative) in patients who did not show left ventricular (LV) mass regression (all P \ 0.001). Baseline global strain was the strongest predictor of lack of LVMR (odds ratio 3.5 (95 % confidence interval 3.0–4.9), P \ 0.001), and GLS value C-9.9 % predicted lack of LVMR with 95 % sensitivity and 87 % specificity (P \ 0.001). Other multivariable predictors were the
S. Gelsomino F. Luca` O. Parise J. G. Maessen Department of Cardiothoracic Surgery, University Hospital, Maastricht, The Netherlands S. Gelsomino (&) O. Parise C. M. Rao G. F. Gensini Experimental Surgery Unit, Department of Heart and Vessels, Careggi Hospital, Viale Morgagni 85, 50134 Florence, Italy e-mail: [email protected] R. Lorusso E. Vizzardi Cardiac Surgery, Civic Hospital, Brescia, Italy
preoperative LV mass value (cutoff value C147 g/m2, P \ 0.001), baseline effective orifice area index (cutoff B0.35 cm2/m2, P = 0.01), and baseline mean gradient (cutoff C58 mmHg, P = 0.01). Finally, we failed to find interactions between GLS and other significant parameters (all P\0.05). Global longitudinal strain accurately predicts LV mass regression in patients with pure AS undergoing AVR. Our findings must be confirmed by further larger studies. Keywords Strain
Aortic stenosis Aortic valve replacement
Introduction In chronic aortic stenosis (AS), left ventricular hypertrophy (LVH) develops as an adaptive mechanism in response to increased pressure load, acting to normalize parietal wall stress [1, 2]. These changes in left ventricular (LV) geometry allow preservation of a normal ejection fraction despite depressed LV myocardial systolic function [3–6]. This, in turn, causes an increase in LV mass, w
Data Loading...
