Abstract 4700: Changes in Left Ventricular Myocardial Strain after Aortic Valve Replacement: Comprehensive 2-Dimensional Speckle Tracking Strain Imaging Assessment
Background: In patients with severe aortic stenosis and preserved left ventricular (LV) ejection fraction (EF), the presence of subtle left ventricular (LV) dysfunction may be misdiagnosed by the standard methods. Two-dimensional speckle tracking strain imaging enables multidirectional assessment of LV myocardial strain.
Objectives: To evaluate the presence of subtle LV dysfunction in patients with severe aortic stenosis by using 2-dimensional speckle tracking imaging and the recovery of myocardial function after aortic valve replacement (AVR).
Methods: Changes in radial, circumferential and longitudinal strain/strain rate of the LV were evaluated by using 2-dimensional speckle tracking imaging in 100 severe aortic stenosis patients after AVR. Radial and circumferential strain/strain rate were assessed at mid ventricular short axis level of the LV. Longitudinal strain/strain rate were evaluated at the conventional 2-, 4-chambers and long-axis apical views of the LV. These LV functional parameters were compared to conventional LVEF.
Results: After AVR (median follow-up 5.3 months), the aortic valve area significantly increased (from 0.8 ± 0.2 cm2 to 1.6 ± 0.5 cm2, p<0.001) together with a significant decrease in the maximal transaortic pressure gradient (from 72 ± 21 mmHg to 22 ± 9 mmHg, p<0.001). In addition, a significant regression of LV mass index was observed (from 154 ± 48 g/m2 to 132 ± 44 g/m2, p<0.001). The LVEF remained unchanged at follow-up whereas a significant improvement of LV longitudinal and circumferential shortening was observed (Table⇓).
Conclusions: In severe aortic stenosis patients, impaired LV longitudinal and circumferential shortening exist although preserved LVEF. After AVR, myocardial strain improves significantly in these two directions. Two-dimensional speckle tracking strain imaging enables an early detection of these subtle changes in LV performance.