P382Early changes in left ventricular longitudinal and rotational function after surgical aortic valve replacement for severe aortic stenosis: 2D strain echocardiographic study


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Abstract

Background: Aortic stenosis induces a chronic pressure overload of left ventricle (LV), leading to LV hypertrophy. In patients with severe aortic stenosis (AS), subclinical left ventricular systolic dysfunction could exist and could be underestimated by conventional echocardiography. There is limited information regarding early changes in LV longitudinal and rotational mechanics following aortic valve replacement (AVR).Purpose: We sought to characterize early modifications of LV longitudinal systolic function and apical rotation using speckle tracking analysis in patients with severe AS before and 4 months after AVR.Methods: We studied 60 patients (mean age 66.2±9.2 ys, 32 males) with severe aortic stenosis (mean gradient:45.9±11.9 mmHg, aortic valve area 0.8±0.2 cm2) submitted to AVR and 40 healthy age-matched controls (64.9±8.8 years, 21 males). Conventional and 2D strain echocardiography were performed before AVR and 4 months after AVR. 2D strain parameters related to LV myocardium were sampled in apical 4 and 2 chambers views (longitudinal) and in short-axis apical level (rotational). All patients had preserved ejection fraction (EF > 50%).Results: Patients with AS showed significant improvement in LV EF following AVR (58,9±6,9% vs. 61,6±7,2%, p<0.02). In comparison with controls, LV global longitudinal strain (LS) was significantly reduced in AS (-21.1±3.4 vs. −15,9±3,9%, p<0.001) and increased following AVR (−18.7±4.2%,P<0.001). Apical rotation in AS was significantly higher than controls, (12.5±4.4 vs 8.4±1.6°, P<0.001) and remained unchaged following AVR (11.9±3.5°). Improvement in LS showed univariate association with younger age, higher values of preoperative aortic valve area and absence of diabetes. On mutivariable logistic regression, however, absence of pre-operative dyslipidemia was the only independent predictor of post-operative improvement in LS (Odds ratio: 0.15, C.I: 0.03-0.77, P=0.02).Conclusions: For patients with severe AS, we found early recovery of longitudinal LV mechanics following AVR. Further investigations are needed for a better knowledge of the LS prognostic value as a marker of subclinical LV dysfunction.

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