Changes in dynamic left ventricular function, assessed by the strain-volume loop, relate to reverse remodeling after aortic valve replacement

Abstract

Aortic valve replacement (AVR) leads to remodeling of the left ventricle (LV). Adopting a novel technique to examine dynamic LV function, our study explored whether post-AVR changes in dynamic LV function and/or changes in aortic valve characteristics are associated with LV mass regression during follow-up. We retrospectively analyzed 30 participants with severe aortic stenosis who underwent standard transthoracic echocardiographic assessment before AVR [88 (IQR or interquartile range: 22–143) days], post-AVR [13 (6–22) days], and during follow-up [455 (226–907) days]. We assessed standard measures of LV structure, function, and aortic valve characteristics. Novel insight into dynamic LV function was provided through a four-chamber image by examination of the temporal relation between LV longitudinal strain (ε) and volume (ε-volume loops), representing the contribution of LV mechanics to volume change. AVR resulted in immediate changes in structural valve characteristics, alongside a reduced LV longitudinal peak ε and improved coherence between the diastolic and systolic part of the ε-volume loop (all P < 0.05). Follow-up revealed a decrease in LV mass ( P < 0.05) and improvements in LV ejection fraction and LV longitudinal peak ε ( P < 0.05). A significant relationship was present between decline in LV mass during follow-up and post-AVR improvement in coherence of the ε-volume loops ( r = 0.439, P = 0.03), but not with post-AVR changes in aortic valve characteristics or LV function (all P > 0.05). We found that post-AVR improvements in dynamic LV function are related to long-term remodeling of the LV. This highlights the potential importance of assessing dynamic LV function for cardiac adaptations in vivo. NEW & NOTEWORTHY Combining temporal measures of left ventricular longitudinal strain and volume (strain-volume loop) provides novel insights in dynamic cardiac function. In patients with aortic stenosis who underwent aortic valve replacement, postsurgical changes in the strain-volume loop are associated with regression of left ventricular mass during follow-up. This provides novel insight into the relation between postsurgery changes in cardiac hemodynamics and long-term structural remodeling, but also supports the potential utility of the assessment of dynamic cardiac function.

Speckle tracking echocardiographic assessment of left ventricular function by myocardial strain before and after aortic valve replacement

“…Our study shows gives impetus to the thought of intervening early in aortic valve disease by incorporating strain analysis in evaluation of patients for aortic valve replacement. Similar results were observed in many other studies [ 5 , 23 – 26 ]. Al-Rashid et al found that the global longitudinal strain (GLS) 1 week following TAVR was comparable to that at baseline (−15,9 ± 4.3 vs −16.8 ± 4.1; p = NS) but significantly improved at 3 months following TAVR (−15.9 ± 4.3% vs. −19.5 ± 3.5%; p < 0.001).…”

Left ventricular strain-volume loops and diastolic dysfunction in suspected heart failure with preserved ejection fraction

“…Our finding that the SVL can detect abnormalities in different cardiac pathologies is in line with earlier studies. Specifically, in previous work we found uncoupling to be higher in both patients with aortic regurgitation and aortic stenosis, whilst changes in uncoupling were also significantly related to cardiac remodeling after aortic valve replacement [11,12]. Pagourelias et al detected a greater uncoupling in potentially stiffer hearts in hypertrophic cardiomyopathy [27].…”

“…The strain(ε)-volume loop (SVL) is an echocardiography-based measure that evaluates the dynamic relationship between LV volume and global longitudinal strain across the total cardiac cycle [11][12][13][14][15]. We previously reported that the SVL can successfully detect changes in systolic and diastolic function upon alterations in pre-and afterload, an ability that is also present when using the invasive pressure-volume curve [16,17], whilst the SVL can also distinguish between various cardiac abnormalities [11], and has potential to provide additional predictive value in clinical populations [12,18]. Therefore, this study will evaluate the relation between the SVL characteristics and presence of diastolic dysfunction (DD) in patients suspected of having HFpEF.…”

Acute exercise-induced changes in cardiac function relates to right ventricular remodeling following 12-wk hypoxic exercise training

“…(28) We found that post-surgery changes in LV strain-volume loop characteristics relate to subsequent cardiac remodeling in patients with aortic stenosis. (17) Therefore, these changes may serve as a proxy of changes in wall stress. Furthermore, we observed different RV loop characteristics in the 'four cornerstones' of the Mitchell classification of sports potentially due to their difference in cardiac structure and function.…”