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Alterations in Layer-Specific Left Ventricular Global Longitudinal and Circumferential Strain in Patients With Aortic Stenosis: A Comparison of Aortic Valve Replacement versus Conservative Management Over a 12-Month Period
Journal of the American Society of Echocardiography ( IF 6.5 ) Pub Date : 2018-09-17 , DOI: 10.1016/j.echo.2018.07.015
Matle J. Fung , Liza Thomas , Dominic Y. Leung

Background

Impairment in left ventricular (LV) systolic strain in aortic stenosis (AS) is well documented. However, alterations in layer-specific LV global longitudinal strain (GLS) and global circumferential strain (GCS) and their recovery following surgical aortic valve replacement (AVR) have not been established. The aim of this study was to examine layer-specific changes in GLS and GCS in patients with AS undergoing AVR and compare these patients with those managed conservatively over 12 months.

Methods

Eighty-six patients (mean age, 68.8 ± 12 years; 60 men) with AS (19 mild, 15 moderate, and 52 severe) were prospectively recruited. Patients with coronary disease or other significant valvular disease were excluded. Forty patients (46.5%) with severe AS underwent AVR. All patients underwent baseline echocardiography. Patients managed conservatively underwent follow-up echocardiography at 12 months. Patients undergoing AVR underwent follow-up echocardiography at 1 week and 3, 6, and 12 months after AVR.

Results

There was worsening in subendocardial but not subepicardial or transmural GLS even in mild AS (−20.9 ± 1.0% vs −20.6 ± 0.8%, P = .012). In moderate AS, worsening in subendocardial (−19.6 ± 0.9% vs −18.2 ± 1.5%, P = .003), subepicardial (−14.9 ± 1.0% vs −13.8 ± 1.2%, P = .004), and transmural (−17.1 ± 0.9% vs −15.8 ± 1.3%, P = .03) GLS and a trend toward significant worsening in subendocardial GCS (−29.8 ± 5.16% vs −27.5 ± 5%, P = .054) were seen. Conservatively managed patients with severe AS had significant worsening in subendocardial (−16.1 ± 1.6% vs −13.9 ± 2.6%, P = .021), subepicardial (−11.6 ± 1.1% vs −10.1 ± 2.1%, P = .027), and transmural (−13.6 ± 1.3% vs −11.8 ± 2.3%, P = .02) GLS and subendocardial (−24.9 ± 3.6% vs −20.8 ± 4.5%, P = .002) and transmural (−16.9 ± 1.7% vs −14.3 ± 3.5%, P = .04) GCS on follow-up. Patients after AVR demonstrated significant improvement in GLS (from 3 months) and GCS (from 6 months) in both myocardial layers.

Conclusions

Patients with AS managed conservatively had worsening of GLS over 12 months despite preserved LV ejection fraction, detected earliest in the subendocardial layer. GCS became progressively impaired in moderate and severe AS. Improvement in LV strain after AVR was seen earlier with GLS (from 3 months) than with GCS (from 6 months) in both myocardial layers.



中文翻译:

主动脉瓣狭窄患者的特定层左心室总纵向和周向应变的变化:12个月期间主动脉瓣置换术与保守治疗的比较

背景

充分记录了主动脉瓣狭窄(AS)的左心室(LV)收缩压损伤。但是,尚未确定特定层的LV总纵向应变(GLS)和总周向应变(GCS)的变化及其在手术主动脉瓣置换(AVR)后的恢复情况。这项研究的目的是检查接受AVR的AS患者的GLS和GCS的层特异性变化,并将这些患者与保守治疗12个月的患者进行比较。

方法

前瞻性招募了86例AS患者(平均年龄68.8±12岁;男性60例)(轻度19例,中度15例,重度52例)。排除患有冠状动脉疾病或其他重大瓣膜疾病的患者。40例重度AS患者(46.5%)接受了AVR。所有患者均接受了基线超声心动图检查。保守治疗的患者在12个月时接受了超声心动图检查。接受AVR的患者在AVR后1周,3、6和12个月接受超声心动图检查。

结果

即使在轻度AS中,心内膜下GLS恶化,但心外膜下或透壁GLS却没有恶化(−20.9±1.0%vs -20.6±0.8%,P  = .012)。在中度AS中,心内膜下(−19.6±0.9%vs −18.2±1.5%,P  = 0.003),心外膜下(−14.9±1.0%vs −13.8±1.2%,P  = 0.004)和透壁(-)恶化观察到17.1±0.9%vs --15.8±1.3%,P  = .03)和心内膜下GCS显着恶化的趋势(-29.8±5.16%vs -27.5±5%,P  = .054)。保守治疗的重度AS患者 在心内膜下(-16.1±1.6%vs -13.9±2.6%,P = .021),心外膜下(-11.6±1.1%vs −10.1±2.1%,P = .027),透壁(−13.6±1.3%vs −11.8±2.3%,P  = .02)GLS和心内膜下(−24.9±3.6%vs −20.8±4.5%,P  = .002)和透壁(− 16.9±1.7%vs −14.3±3.5%,P  = .04)GCS随访。AVR后的患者在两个心肌层均显示GLS(3个月起)和GCS(6个月起)显着改善。

结论

尽管在左心内膜下层最早发现左心室射血分数,但保守治疗的AS患者在12个月内GLS恶化。GCS在中度和重度AS中逐渐受损。在两个心肌层中,GLS(3个月起)比GCS(6个月起)更早地观察到AVR后LV应变的改善。

更新日期:2018-09-17
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