Abstract 3185: Regional Left Ventricular Myocardial Function After Aortic Valve Replacement
Background: In the presence of severe aortic stenosis (AS), assessment of left ventricular myocardial function by ejection fraction (LVEF) is complicated by ventricular remodelling. Speckle tracking echocardiography is a new method for multidirectional analysis of regional myocardial function. We investigated the differences between longitudinal, radial and circumferential myocardial function in patients before and after aortic valve replacement (AVR) in comparison to conventional echocardiographic parameters.
Methods: 25 consecutive patients (14 male, 11 female, age 62±6 years) with AS were examined by echocardiography before (U1), within 1 week after AVR (U2) and after 6 months (U3). We calculated valve area, left ventricular mass and LVEF. Maximal longitudinal (LS) and radial (RS) strain was determined in 18 segments (4-, 3- and 2-chamber view) and maximal circumferential strain in 6 segments (short axis at papillary muscle level) using commercially available software.
Results: After AVR, valve area increased (1.34±0.4 vs. 0.57±0.2 cm2, p<0.05) and remained stable after 6 months. Left ventricular mass remained unchanged from U1 to U2 (334±65 vs. 340±83 g, n.s.), but decreased significantly in U3 (262±54 g, p<0.05). LVEF did not change after AVR nor after 6 months (57±9 vs. 59±6 vs. 60±5 %, n.s.). LS (−17.5±4.6 vs. −17.1±4.9 %, n.s.), RS (45.1±.3 vs. 49.8±20.6 %, n.s.) and CS (−15.7±3.7 vs. −16.7±3 %, n.s.) did not change significantly from U1 to U2. However, after 6 months (U3) LS increased by 11% (−19.8±5.1 %, p<0.05), RS by 26 % (56.7 ± 27.8 %, p<0.05) and CS by 25 % (−19.7 ± 4.6 %, p<0.05) in comparison to U1.
Conclusion: Left ventricular hypertrophy in aortic stenosis leads to a significantly reduced regional myocardial deformation persisting after valve replacement despite of sustained LVEF. Six months after operation, with reduction of hypertrophy, a significant increase in strain values occurred. Longitudinal, radial and circumferential function changed in different degrees.