Author + information
- Sheila Sahni,
- Partho P. Sengupta,
- Giuseppe Caracciolo,
- Jagat Narula,
- Samin Sharma and
- Annapoorna Kini
Previous studies have reported impairment of longitudinal left ventricular (LV) function in patients with aortic stenosis (AS). Few have examined the differences in multidirectional strains for explaining the differences in contractile reserve. We hypothesized that changes in LV transverse shortening compensate for contractile dysfunction in the longitudinal direction and may predict hemodynamics and clinical outcomes of patients with AS and reduced ejection fraction (EF).
Seventy–six patients with symptomatic severe AS and depressed EF (<50%) underwent echocardiography followed by invasive hemodynamic assessments. Patients were divided into three groups: low gradient with contractile reserve seen with dobutamine infusion (n=24), absence of contractile reserve (n=31) and reduced EF with high gradients (n=21). Magnitude and time to peak transverse (TS) and longitudinal strains (LS) were measured from apical four–chamber view and correlated with invasive measurements and assessed for their prognostic value.
All three groups showed equal reduction in LS and similar timing of peak LS. In contrast, TS was higher (P=0.02) and time–to–peak TS were longer (P=0.06) in LV lateral base for patients with contractile reserve. On multivariable analysis, LS and left atrial size independently correlated with mean pulmonary capillary wedge pressure (R2= 0.56, p=0.002 and 0.01 respectively); whereas, time–to–peak TS was an independent correlate of resting cardiac index (R2= 0.37, p=0.02). A total of 36 deaths were recorded during a median follow up interval of 1.8 years. Time–to–peak TS was an independent predictor of survival (Hazard ratio: 1.002; P=0.009). In sequential Cox models, the model based on clinical data (overall ?2, 5.9) was improved by addition of aortic valve area, gradient and ejection fraction (14.7, P=0.01) and further increased by time–to–peak TS (20.4, P=0.002).
For patients with AS and reduced LV EF, longitudinal strain is associated with severity of LV diastolic dysfunction, whereas transverse strain dyssynergy is associated with a lack of contractile reserve and lower cardiac output, and identifies patients with poor outcomes.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.–10:45 a.m.
Session Title: Valvular Heart Disease: Clinical I – Aortic Stenosis
Abstract Category: 31. Valvular Heart Disease: Clinical
Presentation Number: 1113–86
- 2013 American College of Cardiology Foundation