Abstract 668: 2D Longitudinal Myocardial Strain: A More Sensitive Parameter of Left Ventricular Dysfunction in Aortic Valve Stenosis?
Background: In aortic stenosis (AS), ejection fraction (EF) might be preserved despite reduced left ventricular (LV) function. Stress-corrected midwall shortening (scMWS) has been suggested to be a better marker of early LV dysfunction and a predictor of symptom onset. Less is now about myocardial deformation assessed as 2D strain in AS.
Methods: Conventional and 2D speckle tracking echocardiography was performed in 70 patients (40 asymptomatic) with AS (mean age 73±10 years, 54% women). LV function was assessed as peak systolic longitudinal strain (LS), biplane EF and scMWS. Severity of AS was assessed from the energy loss index. LS measurements were also averaged to obtain a global LV strain value.
Results: Severe AS was present in 30 patients (43%) (mean energy loss index 0.44 cm2/m2), 22 symptomatic. LS was lower in the basal septum (−11±6 vs. −8±6%), and in the lateral wall (−16±5 vs. −14±6%) in patients with severe vs. mild/moderate AS, and lower in the lateral wall in symptomatic vs. asymptomatic patients (−16±5 vs. −13±6%) (all p<0.05). Symptomatic patients had lower average LS (−16±4 vs. −14±4%, p<0.05). In univariate analysis, average LS was significantly correlated with scMWS (r=−0.43, p<0.001). In multivariate regression analysis, lower average LS was associated with lower scMWS, EF and energy loss index, and with male gender (all p<0.05) (R2=0.72) (Table⇓).
Conclusions: In patients with AS, lower regional and average LS is associated with more severe AS and presence of symptoms. Average LS is independently associated with EF, and even stronger with scMWS, supporting its use as a marker of global LV dysfunction.