121Asymptomatic left ventricular dysfunction and prediction of symptoms by speckle-tracking echocardiography in chronic aortic regurgitation

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Background: Patients with chronic aortic regurgitation (AR) are asymtomatic for a long time. The recognition of the conversion from normal left ventricular (LV) function to systolic dysfunction and initial clinical symptoms remains an important target for clinicians in the decision-making process.The goal of our study was to find subclinical signs of LV dysfunction and to determine independent predictors of clinical symptoms by speckle-tracking echocardiography in chronic AR patients.Methods: The study population consisted of 66 asymptomatic AR (moderate/severe AR – 53/13), 35 symptomatic AR (moderate/severe AR – 4/31) and 107 healthy controls. Patients underwent a standard transthoracic echocardiographic study including measurements of LV dimensions, LV ejection fraction, diastolic function. LV systolic global longitudinal (SL), radial (SR), circumferential deformation (SC), basal and apical rotation, LV torsion were were measured off – line by 2 dimentional speckle -tracking imaging.Results: The groups did not differ in age, gender. LV end diastolic and systolic diameters and volumes were higher in AR groups (p<0.001). LV ejection fraction was slightly reduced in symptomatic AR compared with asymptomatic AR and controls (52,0±8,87% vs 57,9±4,91% vs 59,3±3,64%; p≤0.001). The ratio E/E' was higher in symptomatic AR compared with asymptomatic AR and controls (10,3±4,1 vs 7,8±2,4 vs 10,3±4,1 respectively; p<0.001).The global systolic SL was lower in symptomatic and asymptomatic AR groups compared to the controls (−16.3±3.8% vs −18.8±2,4% vs −20.3±2.1 % respectively, p<0.01), and the SL in symptomatic AR was lower compared to asymptomatic AR (p<0,01). Asymptomatic AR had increased apical rotation (11.6±4.50 vs 9.6±4.20, p<0.05) and twist (18.1±5.70 vs 16.3±4.90, p<0.05) compared to controls. LV torsion (1.7±0.58 vs 2.05±0.72, p<0.05), SR (37.0±11.1 vs 45.8±11.8, p<0.05) and SC (−19.3±3.6 vs −21.1±2.8, p<0.05) were reduced in symptomatic AR compared to asymptomatic AR. Multiple regression logistic analysis (age, SL, SR, SC, LV end systolic diameter, torsion were included into analysis) showed global SL (OR 1.28, 95% CI 1.0–1.62, p=0.04) and E/E' ratio (OR 1.3, 95% CI 1.06-1.58, p=0.009) as independent predictors for heart failure symptoms.ROC analysis revealed that a global SL of –17.8 % was best predictor of symptoms with 77% sensitivity and 68% specificity (AUC 0.73, p<0.001, 95% CI 0.61-0.84).Conclusions: Asymptomatic AR is related with reduced LV SL, increased apical rotation and twist, whereas symptomatic AR have reduced LV torsion, SC and SR. Reduced global SL predicts heart failure symptoms.

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