PS 08-66 THE IMPACT OF HYPERTENSION AND LV DIMENSION ON LV SUBCLINICAL DYSFUNCTION IN MORE THAN MODERATE TO SEVERE ASYMPTOMATIC AORTIC REGURGITATION WITH NORMAL LV SYSTOLIC FUNCTION: INSIGHT FROM MULTILAYER SPECKLE TRACKING ECHOCARDIOGRAPHY

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Abstract

Objective:

LV systolic function and end-systolic, end-diastolic LV dimension (LVESD, LVEDD) are regarded as important parameters when considering AV surgery for patients with asymptomatic AR. Patients with asymptomatic AR show subclinical LV longitudinal axis dysfunction, with more attenuation demonstrated in hypertensive than in normotensive patients. The aims of our study were to detect signs of subclinical LV dysfunction and to determine the impact of hypertension and LV dimension on LV systolic dysfunction in patients with chronic asymptomatic AR using multilayer-speckle-tracking echocardiography (MSTE).

Design and method:

Conventional echocardiography and 2D MSTE were performed in 37 normal patients and 85 patients (mean 53.6 ± 13.6 yr) with more than moderate to severe chronic AR (vena contracta > 0.6 cm, ERO > 0.3 cm2 or regurgitant volume > 60mL) and normal LVEF (≥ 50%) and without overt coronary artery disease. Multilayer-Global longitudinal strain (GLS) was calculated by 2D MSTE.

Results:

Patients were divided into each of four groups by the 65 mm of LVEDD or the 50 mm of LVESD by the current ACC/AHA VHD guideline; group 0: LVESD ≤ 50 mm or LVEDD ≤ 65 mm and HTN (−), group 1: LVESD ≤ 50 mm or LVEDD ≤ 65 mm and HTN (+), group 2: LVESD > 50 mm or LVEDD > 65 mm and HTN (−), group 3; LVESD > 50 mm or LVEDD > 65 mm and HTN (+). Clinical characteristics, IVSd and LVPWd were no significant differences between four groups. LVMI was the largest in the LVEDD > 65 mm or LVESD > 50 mm and HTN group. And, GLS was the lowest in the LVEDD > 65 mm or LVESD > 50 mm and HTN group. GLS of endocardium, mid-wall, and epicardium was reduced when the LVEDD was more than 65 mm or LVESD was more than 55 mm.

Conclusions:

Patients with asymptomatic chronic AR showed subclinical LV longitudinal axis dysfunction, with more attenuation demonstrated in hypertensive than in normotensive and with the LVEDD > 65 mm or LVESD > 50 mm. Our results suggest that MSTE may compliment evaluation of patients with asymptomatic chronic AR.

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