Pathophysiological background and prognostic implication of systolic aortic root motion in non-ischemic dilated cardiomyopathy

Abstract

Recordings of aortic root movement represent one of the first accomplishments of ultrasound in medicine and mark the beginning of functional cardiac imaging. However, the underlying mechanism is not completely understood. Since the aortic root is directly connected to the cardiac skeleton we hypothesize, that the amplitude of systolic aortic root motion (SARM) may be mainly caused by displacement of the cardiac base towards the apex and might therefore be used as measure of left ventricular longitudinal function (LV-LF). One hundred and eighty patients with dilated cardiomyopathy and 180 healthy controls were prospectively included into this study. SARM was lower in patients compared to controls (9 ± 3 mm vs. 12 ± 2 mm, p < 0.001) and lowest in patients with cardiovascular events (9 ± 3 mm vs. 7 ± 3 mm, p < 0.001). During a median follow-up time of 38 months, the combined end-point of cardiovascular death or hospitalization for heart failure was reached by 25 patients (13.9%). Reduced SARM had significant prognostic impact on outcome (hazard ratio 0.74, 95% confidence interval 0.63–0.88, p < 0.001) and remained an independent predictor in the multivariate analysis. Compared to parameters with potential influence on its mechanism, SARM correlated best (r = 0.75, p < 0.001) with global longitudinal strain (GLS). SARM may therefore represent an alternative echocardiographic parameter for the assessment of LV-LF, particularly when GLS is not feasible or apical views are not available.

Systolic aortic root motion predicts response to cardiac resynchronization therapy

“…24 Aortic root is directly connected to cardiac skeleton, and the amplitude of SARM may reflect the movement of the cardiac base towards the apex and may be used as a measure of left ventricular longitudinal function. 11,25 In another study, conducted by, Aurich et al have found that SARM was decreased in patients with dilated cardiomyopathy. 11 Our study showed reduced SARM in patients with nonresponse to CRT and higher SARM values related with response to CRT.…”

“…Decreased aortic root motion is seen in low cardiac output states, with corresponding low volumes of atrial filling and emptying . Aortic root is directly connected to cardiac skeleton, and the amplitude of SARM may reflect the movement of the cardiac base towards the apex and may be used as a measure of left ventricular longitudinal function . In another study, conducted by, Aurich et al have found that SARM was decreased in patients with dilated cardiomyopathy …”

“…SARM measures were made in a different session from the records and SARM was evaluated before the device implantation. SARM measured with the M‐mode beam was placed through the center of the aortic roots cross section (Figure , and ). SARM was defined as systolic displacement of anterior wall of aorta by M‐Mode echocardiography.…”

“…Displacement of the aortic root during the cardiac cycle is also a well‐established phenomenon and systolic aortic root motion (SARM) could be easily obtained by M‐Mode echocardiography . Aortic root movement was studied in several patients group and SARM was recently evaluated in patients with dilated cardiomyopathy . SARM was not previously assessed in patients with CRT.…”

“…8,9 Aortic root movement was studied in several patients group 8,10 and SARM was recently evaluated in patients with dilated cardiomyopathy. 11 SARM was not previously assessed in patients with CRT. The aim of the present study was to evaluate relationship between SARM as potential echocardiographic predictor and CRT response in patients with HFrEF.…”