Long axis excursion in aortic stenosis

Abstract

OBJECTIVESTo examine long axis excursion in patients with all grades of aortic stenosis and preserved transverse systolic function, and to compare long axis excursion in symptomatic with that in asymptomatic severe aortic stenosis.DESIGNProspective comparative study.SETTINGRegional cardiothoracic centre.PATIENTS78 patients with all grades of aortic stenosis and normal fractional shortening and ejection fraction were studied. There were two comparison groups, 10 age matched normal subjects and 14 patients with aortic stenosis and fractional shortening < 26%.METHODSAortic valve function and left ventricular mass were assessed echocardiographically. M mode measurements of long axis excursion at the septal and lateral sides of the mitral annulus were taken.RESULTSThere were significant differences between the groups in long axis excursion at both the septal (p < 0.0001) and lateral sides of the mitral annulus (p = 0.002 by analysis of variance). Long axis excursion was independently related to both left ventricular mass index (p = 0.001) and the grade of aortic stenosis (p = 0.002). Comparing patients with severe aortic stenosis with and without symptoms, there were significant differences in effective orifice area (p = 0.02 ) and long axis excursion at the lateral side of the mitral annulus (p = 0.04), but not in fractional shortening, ejection fraction, or peak or mean pressure difference.CONCLUSIONIn patients with aortic stenosis, long axis excursion is reduced even in the presence of normal fractional shortening or ejection fraction. It is lower in patients with symptomatic compared with asymptomatic severe aortic stenosis and may be of use in predicting the onset of symptoms.

Left Ventricular Global Longitudinal Strain in Patients with Moderate Aortic Stenosis

“…30,31 Previous studies have shown that a reduction in LV longitudinal function occurs simultaneously with AS progression, even in patients with moderate AS, providing evidence of impaired LV longitudinal strain despite normal LVEF in patients with significant AS. 32,33 In addition, Weidemann et al 15 demonstrated that markers of LV systolic longitudinal function are associated with the severity of myocardial fibrosis in patients with significant AS. On the basis of these studies, the development of LV myocardial fibrosis seems to be one of the main pathophysiologic mechanisms to explain a reduction in LV systolic longitudinal function in patients with significant AS.…”

Distribution and Prognostic Significance of Left Ventricular Global Longitudinal Strain in Asymptomatic Significant Aortic Stenosis

“…The alteration of LV longitudinal function occurs in parallel to AS severity (19), LV morphological changes (20), LV myocardial damage and fibrosis proliferation (11). Weidemann et al (11) reported that the severity of myocardial fibrosis estimated with histological analysis was associated with impairment of LV longitudinal shortening as assessed by mitral annulus displacement using M-mode echocardiography.…”

Prognostic Importance of Left Ventricular Global Longitudinal Strain in Patients with Severe Aortic Stenosis and Preserved Ejection Fraction

“…[20,21] In addition, impairment of LV longitudinal shortening or strain correlates with the presence of symptoms in patients with AS, is associated with LV myocardial fibrosis by cardiac Magnetic Resonance Imaging (cMRI) and predicts elicited symptoms during exercise testing in the subset of asymptomatic patients able to exercise. [22][23][24][25][26] Hence, the assessment of LV GLS may be helpful to identify patients with severe AS who present significant myocardial damage and who are at higher risk, despite preserved LVEF and no or only mild symptoms.…”