Background: The aim of this study was to evaluate the subendocardial wall function using tissue Doppler imaging (TDI) and strain rate imaging (SRI) in patients with congenital aortic stenosis and compare these parameters with the conventional transesophageal assessment of aortic valve area. Methods: We studied with transthoracic and transesophageal echocardiography 24 pts aged 14-47 years with congenital aortic valvar stenosis. 14 age-and sex-matched subjects with no signs of heart disease were selected as normal controls (CTR). On the basis of the NYHA class, pts were distinguished in two groups: group 1 (13 pts), NYHA class I-II; group 2 (11 pts), NYHA class III-IV. TDI wall velocities during systole (Sw), early relaxation (Ew) and atrial systole (Aw) were measured in both groups in the apical four chambers views. Peak strain () and strain rate (SR) were measured during isovolumic contraction, systole, isovolumic relaxation, early diastole and late diastole in endocardium (End), myocardium (Myo) and epicardium (Epi) in the same views. Aortic valve area was determined by planimetry in the transesophageal short axis view. Results: Compared to controls, a marked decrease in endocardial strain and strain rate was shown both in Group 1 (p<0.05) and Group 2 pts (p<0.001). In multivariate analysis, the only factors associated with the presence of symptoms were pressure gradient (p<0.05), aortic valve area (p<0.005), End- (p<0.005), and End-SR (p<0.005). ROC curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the prediction of symptoms were 60mmHg for the pressure gradient, 0.60 cm2/m2 for aortic valve area, 20% for End-, and 2.5sec-1 for End-SR. The combination of pressure gradient, aortic valve area and SRI parameters resulted in an improvement of the overall performance for the prediction of symptoms. Conclusion: Strain Doppler echocardiography provides a unique insight in evaluating subendocardial wall dysfunction in pts with aortic stenosis and has an incremental value in the prediction of severity compared to the transesophageal assessment of aortic valve area.
Strain Doppler echocardiographic assessment of subendocardial dysfunction in aortic stenosis: Additional value in the prediction of severity compared to conventional parameters / Vitarelli, Antonino; Conde, Y; Cimino, E; Stellato, S; D'Angeli, Ilaria; D'Orazio, Simona; Padella, V; Battaglia, Daniela; Caranci, Fiorella; Continanza, Giovanna. - In: JOURNAL OF CARDIAC FAILURE. - ISSN 1071-9164. - STAMPA. - 11/6 (Suppl):(2005), p. S202. (Intervento presentato al convegno 9th Annual Scientific Meeting of Heart Failure Society of America tenutosi a Boca Raton, Florida, USA nel 18-21 Sett. 2005).
Strain Doppler echocardiographic assessment of subendocardial dysfunction in aortic stenosis: Additional value in the prediction of severity compared to conventional parameters
VITARELLI, Antonino;D'ANGELI, ILARIA;D'ORAZIO, SIMONA;BATTAGLIA, DANIELA;CARANCI, FIORELLA;CONTINANZA, GIOVANNA
2005
Abstract
Background: The aim of this study was to evaluate the subendocardial wall function using tissue Doppler imaging (TDI) and strain rate imaging (SRI) in patients with congenital aortic stenosis and compare these parameters with the conventional transesophageal assessment of aortic valve area. Methods: We studied with transthoracic and transesophageal echocardiography 24 pts aged 14-47 years with congenital aortic valvar stenosis. 14 age-and sex-matched subjects with no signs of heart disease were selected as normal controls (CTR). On the basis of the NYHA class, pts were distinguished in two groups: group 1 (13 pts), NYHA class I-II; group 2 (11 pts), NYHA class III-IV. TDI wall velocities during systole (Sw), early relaxation (Ew) and atrial systole (Aw) were measured in both groups in the apical four chambers views. Peak strain () and strain rate (SR) were measured during isovolumic contraction, systole, isovolumic relaxation, early diastole and late diastole in endocardium (End), myocardium (Myo) and epicardium (Epi) in the same views. Aortic valve area was determined by planimetry in the transesophageal short axis view. Results: Compared to controls, a marked decrease in endocardial strain and strain rate was shown both in Group 1 (p<0.05) and Group 2 pts (p<0.001). In multivariate analysis, the only factors associated with the presence of symptoms were pressure gradient (p<0.05), aortic valve area (p<0.005), End- (p<0.005), and End-SR (p<0.005). ROC curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the prediction of symptoms were 60mmHg for the pressure gradient, 0.60 cm2/m2 for aortic valve area, 20% for End-, and 2.5sec-1 for End-SR. The combination of pressure gradient, aortic valve area and SRI parameters resulted in an improvement of the overall performance for the prediction of symptoms. Conclusion: Strain Doppler echocardiography provides a unique insight in evaluating subendocardial wall dysfunction in pts with aortic stenosis and has an incremental value in the prediction of severity compared to the transesophageal assessment of aortic valve area.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
