Background

Although aortic valve replacement (AVR) when successfully performed boasts low mortality rates in selected patients, prosthesis–patient mismatch (PPM) can be found in the majority of these individuals. Limited research is available supporting the benefit of two-dimensional speckle tracking echocardiography (2D-STE) in patients with severe PPM. This study sought to assess myocardial strain using 2D-STE to determine the relationship between subclinical left ventricular (LV) dysfunction and aortic PPM in patients undergoing AVR with preserved LV ejection fraction.

Material and methods

We retrospectively examined all consecutive patients with isolated AVR who presented to our center from 2005 to 2018. The data of 1086 patients were analyzed. Severe PPM was defined as an indexed effective orifice area of 0.65 cm²/m² or less. As a result of the detailed assessment, 54 patients meeting the eligibility criteria were included in the study. Baseline data were collected and compared between the two groups of patients with severe PPM (n = 27) and those with normofunctional aortic prosthesis valve as a control group (n = 27). All patients underwent baseline echocardiography. Global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 2D-STE.

Results

When compared with controls, patients with severe PPM had significantly decreased GLS (18.6 ± 2.9 vs. 21.4 ± 2.1; p < 0.01) and GCS (17.2 ± 3.6 vs. 21.7 ± 2.1; p < 0.01) values.

Conclusion

In addition to standard clinical and echocardiographic parameters, GLS and GCS suggest subclinical dysfunction and have incremental value in patients with severe PPM.

中文翻译：

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严重患者假体不匹配的斑点追踪超声心动图

背景

尽管成功实施的主动脉瓣置换术 (AVR) 在选定患者中的死亡率较低，但在这些个体中的大多数中可以发现假体与患者的不匹配 (PPM)。有限的研究支持二维斑点追踪超声心动图 (2D-STE) 对严重 PPM 患者的益处。本研究旨在使用 2D-STE 评估心肌应变，以确定接受 AVR 且左室射血分数保留的患者的亚临床左心室 (LV) 功能障碍与主动脉 PPM 之间的关系。

材料与方法

我们回顾性检查了 2005 年至 2018 年在我们中心就诊的所有孤立性 AVR 患者。分析了 1086 名患者的数据。严重 PPM 被定义为 0.65 cm ² /m ²或更小的索引有效孔面积。作为详细评估的结果，54名符合资格标准的患者被纳入研究。收集并比较两组严重PPM患者（n  = 27）和功能正常的主动脉瓣作为对照组（n  = 27）的基线数据。所有患者均接受基线超声心动图检查。通过 2D-STE 评估全局纵向应变 (GLS) 和全局周向应变 (GCS)。

结果

与对照组相比，严重 PPM 患者的 GLS (18.6 ± 2.9 vs. 21.4 ± 2.1; p  < 0.01) 和 GCS (17.2 ± 3.6 vs. 21.7 ± 2.1; p  < 0.01) 值显着降低。

结论

除了标准的临床和超声心动图参数外，GLS 和 GCS 还提示亚临床功能障碍，并且对严重 PPM 患者具有增量价值。