P976Comparative assessment of pressure and volume overload on left ventricular contractility in patients with aortic stenosis and aortic regurgitation : a velocity-vector imaging based study


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Abstract

Objectives: Aortic stenosis (AS) causes pressure overload and aortic regurgitation (AR) results in volume overload. Both of the two conditions induce impairment in left ventricular (LV) myocardial contractility. We aimed to compare the impact of these two distinct patterns on LV subclinical systolic dysfunction, by using velocity-vector imaging (VVI) derived strain imaging.Methods: We studied 40 patients with moderate to severe AS (72.08±11.14 years and 63 % male), 40 patients with chronic, moderate to severe AR(67.09±9.5 years and 64 % male) and 30 sex and age matched healthy controls. Conventional echocardiography and VVI- based strain imaging were performed to analyze LV systolic function. To evaluate LV longitudinal systolic function, segmental peak systolic strain (S) and strain rate (SRs) data were acquired from apical four chamber, two chamber and long axis views.Results: Longitudinal peak systolic S and SR of the LV were significantly decreased in patients with AS (strain: 12.95 ± 0.44 to 23.73 ± 0.34, p=0.0001, SRs: 0.43 ± 0.20 to 4.94 ± 0.55, p=0.0001),and AR, compared to controls (strain: 16.94 ± 1.83 to 23.73 ± 0.34, p=0.0001, SRs: 0.87 ± 0.08 to 4.94 ± 0.55, p=0.0001). Impairment in LV longitudinal systolic function was more significant in patients with AS.Conclusions: Subclinical LV systolic dysfunction occurs in patients with moderate to severe AS, and chronic AY, despite preserved LV EF. Novel strain imaging method; VVI may be used to identify the impact of both loading conditions on LV myocardium. Aortic stenosis is a more destructive state for the LV contractility, when compared to chronic AR.

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