Abstract 12324: Endocardial Dysfunction in Patients with Chronic Aortic Regurgitation and Preserved Ejection Fraction
Background: Although the assessment of left ventricular (LV) myocardial dysfunction plays an important role for management of patients with chronic aortic regurgitation (AR), it remains difficult to detect subtle LV myocardial dysfunction in such patients with preserved ejection fraction (EF). Accordingly, the objective was to assess the feature of LV myocardial function in chronic AR patients and preserved EF.
Methods: We studied 38 patients with chronic AR patients undergoing surgical correction with EF of 58±7% (all≥50%), regurgitant volume of 64±29ml and regurgitant fraction of 45±13%. Echocardiography was performed before and 13±9 months after surgical correction. Global radial strain was assessed from mid-LV short-axis view using two-dimensional speckle-tracking strain. We evaluated global radial strain in the inner-half (GRSinner), outer-half (GRSouter), and total (GRStotal) layer of LV wall. Furthermore, we evaluated transmural strain profile in the LV posterior wall using myocardial tissue Doppler radial strain, and the location of peak strain was measured as the percentage distance of the wall thickness from the endocardium toward the epicardium. Fifteen EF-matched normal volunteers were studied for comparison.
Results: GRSinner in chronic AR patients was significantly smaller than that in controls (27.3±10.9% vs. 38.4± 10.0%, p<0.05), and the location of peak strain was significantly shifted to the epicardial side compared to that in controls (27.2±13.7% to 16.1±5.5%, p<0.05). On the other hand, GRStotal, GRSouter were similar between both groups. After surgical correction, GRSinner was significantly increased from 27±11% to 37±13% (p<0.01), and the location of peak strain was also significantly shifted from the epicardial side to the endocardial side (27±14% to 19±12%, p<0.05). On the other hand, GRStotal and GRSouter did not change after surgical correction.
Conclusions: The LV endocardium side was significantly impaired in chronic AR patients and preserved EF, and improved after surgical correction. These observations might be useful at evaluating early subtle changes in such patients.
- © 2011 by American Heart Association, Inc.