Background. Patients with chronic severe aortic regurgitation (AR) represent a challenging cohort with high morbidity and mortality. It is known about the implication of left ventricular (LV) strain as a predictor for mortality in patients with chronic AR. The prevalence and clinical impact of right ventricular dysfunction (RVD) on risk stratification and prognosis in these patients is unknown. Methods. Eighteen patients (mean age 64±13 years) with severe chronic AR and eighteen age-matched healthy subjects selected as controls were studied. LV and RV longitudinal, circumferential and radial strains were calculated by three-dimensional speckle tracking echocardiography (3DSTE). Global area strain (GAS) was obtained by 3DSTE as the percentage variation in the surface area defined by the longitudinal and circumferential strain vectors. Data analysis was performed offline. RVD was defined as global longitudinal strain of RV free-wall <15%. Cox proportional hazards modeling was used to risk-adjust comparisons for the end point of all-cause mortality. Results. Impairment of LV global longitudinal strain (-15.9% vs -19.3%, p = .015), global circumferential strain (-17.8% vs -26.4%, p = .006), global radial strain (27.3% vs 34.6%, p = .026) and global area strain (-21.4% vs -38.5%, p = .008) was observed in patients with AR compared to controls. The presence of RVD (hazard ratio, 2.86; 95% CI, 1.36-7.13; p = 0.032) was an independent risk factor associated with all-cause mortality despite several adjustments for potential clinical and echocardiographic confounders such as aortic valve replacement, severity of tricuspid regurgitation, and left ventricular global longitudinal strain. Conclusions. Baseline RVD is common in patients with chronic severe aortic regurgitation. Quantification of right ventricular systolic function in these patients provides important additional prognostic value and risk stratification.
Assessment of biventricular strain by 3-dimensional speckle-tracking echocardiography in chronic aortic regurgitation / Capotosto, Lidia; Ashurov, Rasul; Mangieri, Enrico; Gaudio, Carlo; Vitarelli, Antonino. - In: EUROPEAN HEART JOURNAL. CARDIOVASCULAR IMAGING. - ISSN 2047-2404. - STAMPA. - vol.17(suppl.2):(2016), pp. 147-148. (Intervento presentato al convegno EuroEcho-Imaging 2016 tenutosi a Leipzig, Germany nel 7-10Dec.2016) [10.1093/ehjci/jew250].
Assessment of biventricular strain by 3-dimensional speckle-tracking echocardiography in chronic aortic regurgitation
Lidia Capotosto;Enrico Mangieri;Carlo Gaudio;Antonio Vitarelli
2016
Abstract
Background. Patients with chronic severe aortic regurgitation (AR) represent a challenging cohort with high morbidity and mortality. It is known about the implication of left ventricular (LV) strain as a predictor for mortality in patients with chronic AR. The prevalence and clinical impact of right ventricular dysfunction (RVD) on risk stratification and prognosis in these patients is unknown. Methods. Eighteen patients (mean age 64±13 years) with severe chronic AR and eighteen age-matched healthy subjects selected as controls were studied. LV and RV longitudinal, circumferential and radial strains were calculated by three-dimensional speckle tracking echocardiography (3DSTE). Global area strain (GAS) was obtained by 3DSTE as the percentage variation in the surface area defined by the longitudinal and circumferential strain vectors. Data analysis was performed offline. RVD was defined as global longitudinal strain of RV free-wall <15%. Cox proportional hazards modeling was used to risk-adjust comparisons for the end point of all-cause mortality. Results. Impairment of LV global longitudinal strain (-15.9% vs -19.3%, p = .015), global circumferential strain (-17.8% vs -26.4%, p = .006), global radial strain (27.3% vs 34.6%, p = .026) and global area strain (-21.4% vs -38.5%, p = .008) was observed in patients with AR compared to controls. The presence of RVD (hazard ratio, 2.86; 95% CI, 1.36-7.13; p = 0.032) was an independent risk factor associated with all-cause mortality despite several adjustments for potential clinical and echocardiographic confounders such as aortic valve replacement, severity of tricuspid regurgitation, and left ventricular global longitudinal strain. Conclusions. Baseline RVD is common in patients with chronic severe aortic regurgitation. Quantification of right ventricular systolic function in these patients provides important additional prognostic value and risk stratification.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
