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Speckle tracking echocardiography in severe patient–prosthesis mismatch

Speckle-Tracking-Echokardiographie bei schwerem fehlendem Abgleich zwischen Patient und Prothese

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Abstract

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.

Zusammenfassung

Hintergrund

Auch wenn der Aortenklappenersatz („aortic valve replacement“, AVR) bei erfolgreicher Durchführung niedrige Mortalitätsraten bei ausgewählten Patienten aufweist, findet sich bei der Mehrzahl dieser Personen ein fehlender Abgleich zwischen Prothese und Patient („prosthesis-patient mismatch“, PPM). Es gibt nur wenige Studien, die auf den Nutzen der 2‑dimensionalen Speckle-Tracking-Echokardiographie (2-D-STE) bei Patienten mit schwerem PPM hinweisen. Ziel der vorliegenden Studie war es, die myokardiale Deformierung mittels 2‑D-STE zu bestimmen, um das Verhältnis zwischen subklinischer linksventrikulärer (LV‑)Dysfunktion und Aorten-PPM bei Patienten mit AVR und erhaltener LV-Ejektionsfraktion zu untersuchen.

Material und Methoden

Dazu wurden alle konsekutiven Patienten mit isolierter AVR retrospektiv untersucht, die sich 2005–2018 in der Klinik der Autoren vorstellten. Die Daten von 1086 Patienten wurden ausgewertet. Ein schwerer PPM wurde als eine indizierte effektive Öffnungsfläche von 0,65 cm2/m2 oder weniger definiert. Nach detaillierter Untersuchung wurden 54 Patienten, welche die Eignungskriterien erfüllten, in diese Studie einbezogen. Die Ausgangsdaten wurden erhoben und zwischen der Patientengruppe mit schwerem PPM (n = 27) sowie Patienten mit normofunktionaler Aortenprothesenklappe als Kontrollgruppe verglichen (n = 27). Bei allen Patienten wurde zu Studienbeginn eine Echokardiographie durchgeführt. Der globale longitudinale Strain (GLS) und der globale zirkumferenzielle Strain (GCS) wurden mittels 2‑D-STE bestimmt.

Ergebnisse

Im Vergleich zu den Kontrollen wiesen die Patienten mit schwerem PPM signifikant verminderte GLS- (18,6 ± 2,9 vs. 21,4 ± 2,1; p < 0,01) und GCS-Werte (17,2 ± 3,6 vs. 21,7 ± 2,1; p < 0,01) auf.

Schlussfolgerung

Zusätzlich zu klinischen und echokardiographischen Standardparametern dienen GLS und GCS als Hinweis auf eine subklinische Dysfunktion und haben inkrementellen Wert bei Patienten mit schwerem PPM.

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Authors and Affiliations

  1. Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

    Altuğ Ösken M.D., Şennur Ünal Dayı Prof. M.D., Kazım Serhan Özcan Assoc. Prof. M.D., Esra Poyraz M.D., Ufuk Gürkan Assoc. Prof. M.D. & Neşe Çam Assoc. Prof. M.D.

  2. Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey

    Muhammed Keskin Assoc. Prof. M.D.

  3. Department of Cardiology, Istinye University Faculty of Medicine, Istanbul, Turkey

    Tuğba Kemaloğlu Öz Assoc. Prof. M.D.

  4. Department of Cardiology, Acibadem University Faculty of Medicine, Istanbul, Turkey

    Haldun Akgöz Assoc. Prof. M.D.

  5. Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tibbiye cad. 13, Haydarpasa/Istanbul/Turkey, 34668, İstanbul, Turkey

    Altuğ Ösken M.D.

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  1. Altuğ Ösken M.D.
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Correspondence to Altuğ Ösken M.D..

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Conflict of interest

A. Ösken, Ş. Ünal Dayı, K.S. Özcan, M. Keskin, T. Kemaloğlu Öz, E. Poyraz, U. Gürkan, H. Akgöz and N. Çam declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Ösken, A., Ünal Dayı, Ş., Özcan, K.S. et al. Speckle tracking echocardiography in severe patient–prosthesis mismatch. Herz 46, 375–380 (2021). https://doi.org/10.1007/s00059-021-05031-4

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