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Original article
Valvular heart disease
Myocardial deformation in aortic valve stenosis: relation to left ventricular geometry
  1. Dana Cramariuc1,2,
  2. Eva Gerdts1,2,
  3. Einar Skulstad Davidsen2,
  4. Leidulf Segadal3,
  5. Knut Matre1
  1. 1
    Institute of Medicine, University of Bergen, Bergen, Norway
  2. 2
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
  3. 3
    Department of Surgical Sciences, University of Bergen, Bergen, Norway
  1. Correspondence to Dana Cramariuc, Department of Heart Disease, Haukeland University Hospital, NO-5021, Bergen, Norway; dana.cramariuc{at}helse-bergen.no

Abstract

Objective To assess left ventricular (LV) strain and displacement and their relations to LV geometry in patients with aortic stenosis (AS).

Design Cross-sectional echocardiographic study in patients with AS. Peak circumferential, radial and longitudinal strain, and radial, longitudinal and transverse displacement were measured by 2D speckle tracking. Severity of AS was assessed from energy loss index (ELI). LV hypertrophy was present if LV mass/height2.7 ≥46.7/49.2 g/m2.7 in women/men and concentric LV geometry if relative wall thickness ≥0.43. LV geometry was assessed from LV mass/height2.7 and relative wall thickness in combination.

Setting Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

Patients 70 patients with AS (mean age 73±10 years, 54% women).

Interventions None.

Main outcome measures Association of regional and average LV myocardial strain and displacement with LV geometric pattern and degree of AS.

Results Average longitudinal strain was lower in the hypertrophy groups and correlated with higher LV mass index and relative wall thickness, lower stress-corrected mid-wall shortening and smaller ELI (all p<0.05). Average strain and displacement in other directions did not differ between geometric groups. In multivariate regression analysis, lower average longitudinal strain was associated with higher relative wall thickness (β=0.15), lower ejection fraction (β=−0.16), systolic blood pressure (β=−0.16) and energy loss index (β=−0.20) (all p<0.05) (R2=0.72). When relative wall thickness was replaced with LV mass, lower longitudinal strain was also associated with higher LV mass (β=0.21, p<0.05) (R2=0.73).

Conclusions In patients with AS, lower average longitudinal strain is related to higher LV mass, concentric geometry and more severe AS.

https://doi.org/10.1136/hrt.2009.172569

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    Footnotes

    • See Editorial p 95

    • Disclosures: Eva Gerdts has received honoraria for occasional lectures at scientific symposia sponsored by Merck/Schering-Plough Pharmaceuticals and as member of the Scientific Steering Committee in the SEAS study.

    • Competing interests None.

    • Ethics approval This study was conducted with the approval of all the countries in which patients were recruited.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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