Preoperative Systolic Strain Rate Predicts Postoperative Left Ventricular Dysfunction in Patients With Chronic Aortic Regurgitation

Onishi, Tetsuari; Kawai, Hiroya; Tatsumi, Kazuhiro; Kataoka, Toshiya; Sugiyama, Daisuke; Tanaka, Hidekazu; Okita, Yutaka; Hirata, Ken Ichi

doi:10.1161/circimaging.109.888354

Cited by 44 publications

(27 citation statements)

References 39 publications

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“…21,22 The sensitivity of these measures to alterations in deformation has resulted in their application, in both animal and human studies, to a variety of pathological conditions characterized by myocardial dysfunction despite preserved EF, including asymptomatic carriers of hypertrophic cardiomyopathy sarcomeric mutations, 23 Fabry's disease, 24 myocardial steatosis, 25,26 and rodent models of Duchenne muscular dystrophy. 27 Perhaps because of their less load-dependent nature, these measures have also proven informative in the setting of valvular heart disease in which alterations in loading conditions make EF a less reliable measure of contractile function, including severe aortic stenosis, 28 aortic regurgitation, 29 and mitral regurgitation. 30 In the case of coronary disease, global strain values obtained early after an acute myocardial infarction may effectively predict subsequent remodeling and functional recovery.…”

Section: Deformation Imaging As a Measure Of LV Function Detection Ofmentioning

confidence: 99%

Myocardial Deformation Imaging

2012

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M yocardial deformation imaging is a novel echocardiographic method for assessment of global and regional myocardial function. As this technology has evolved, it has been applied to an increasing number of research questions, and the number of publications incorporating deformation imaging has grown in parallel.Although not yet sufficiently vetted for routine clinical use, these methods offer the long-term potential for more complete, accurate, and reproducible assessment of myocardial function. What Is Myocardial Deformation Imaging?Evaluation of contractile function with echocardiography has traditionally been limited to volume-based assessment of ejection fraction (EF) and assessment of regional wall motion or visual estimation of regional thickening. These methods have suffered from lack of reproducibility and standardization and are generally considered to be extremely sensitive to loading conditions. These limitations have led to an interest in techniques that provide more objective and reproducible measures of contractile function.During systole, the ventricular myocardium simultaneously shortens in the longitudinal and circumferential planes and thickens in the radial plane, with reciprocal changes in diastole ( Figure). Deformation imaging, in the broadest sense, allows for more direct assessment of myocardial muscle shortening and lengthening throughout the cardiac cycle by assessing regional myocardial strain and strain rate. Strain is defined as the change in length of a segment of myocardium relative to its resting length and is expressed as a percentage; strain rate is the rate of this deformation. Longitudinal and circumferential shortening results in negative strain values, whereas radial thickening results in a positive strain value. Previously, assessment of myocardial strain could be performed with the use of sonomicrometry crystals, which can only be performed experimentally 1 or with magnetic resonance imaging-based myocardial tagging, 2,3 which is limited by relatively low temporal resolution and the limited availability and expense of cardiac magnetic resonance imaging. Extension of these techniques to echocardiography has allowed for substantially greater utility in a broader range of patients.Myocardial deformation imaging with echocardiography can be performed with the use of either tissue Doppler-based or 2-dimensional speckle tracking-based methods. Doppler methods, developed initially, utilize the velocity gradient present along the length of the left ventricle (LV) to calculate strain rate, which is then integrated to derive strain. This technique suffers from limitations similar to those of traditional Doppler because it can only accurately assess deformation in the plane incident with the ultrasound beam and requires prospective acquisition of dedicated images at high frame rate. B-mode speckle tracking, sometimes referred to as feature tracking, utilizes the movement of the coherent ultrasound backscatter speckle pattern within B-mode echocardiographic images to assess myocardial...

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Section: Deformation Imaging As a Measure Of LV Function Detection Ofmentioning

confidence: 99%

Myocardial Deformation Imaging

2012

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“…The chronic effects of abnormal loading from valvular disease on myocardial function may be difficult to detect by conventional means, and strain imaging may play a role (61)(62)(63)(64)(65)(66)(67). Delgado et al (62) demonstrated that patients with severe aortic stenosis and preserved EF exhibited decreased radial, circumferential, and longitudinal speckle tracking strain.…”

Section: Applications Of Strain Imaging For Effects Of Valvular Heartmentioning

confidence: 99%

Echocardiographic Assessment of Myocardial Strain

Gorcsan¹,

Tanaka²

2011

Journal of the American College of Cardiology

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416

305

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Echocardiographic strain imaging, also known as deformation imaging, has been developed as a means to objectively quantify regional myocardial function. First introduced as post-processing of tissue Doppler imaging velocity converted to strain and strain rate, strain imaging has more recently also been derived from digital speckle tracking analysis. Strain imaging has been used to gain greater understanding into the pathophysiology of cardiac ischemia and infarction, primary diseases of the myocardium, and the effects of valvular disease on myocardial function, and to advance our understanding of diastolic function. Strain imaging has also been used to quantify abnormalities in the timing of mechanical activation for heart failure patients undergoing cardiac resynchronization pacing therapy. Further advances, such as 3-dimensional speckle tracking strain imaging, have emerged to provide even greater insight. Strain imaging has become established as a robust research tool and has great potential to play many roles in routine clinical practice to advance the care of the cardiovascular patient. This perspective reviews the physiology of myocardial strain, the technical features of strain imaging using tissue Doppler imaging and speckle tracking, their strengths and weaknesses, and the state-of-the-art present and potential future clinical applications.

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“…Therefore, it is not surprising that markers of cardiac dysfunction shown to be associated with poor outcome in mitral regurgitation, such as exercise LV volumes, resting myocardial strain, and resting myocardial strain rate, are also predictors of need for valve surgery in chronic AR. [7][8][9][10][11][12] In contrast, it is unknown whether right ventricular (RV) dysfunction, which seems to be relevant to the outcomes in mitral regurgitation, 13 carries any importance in chronic AR. We have recently developed a framework of assessing incremental value of resting and exercise parameters of both LV and RV function as prognostic parameters of surgical intervention in chronic asymptomatic mitral regurgitation.…”

Section: Clinical Perspective On P 362mentioning

confidence: 99%

“…[8][9][10][11] Although global LV strain is correlated to LVEF, it may be more sensitive in detecting subclinical myocardial dysfunction 24 in the presence of a pathological process such as AR, even when EF is normal. Although LVEF …”

Section: Rest and Exercise LV Dysfunction As A Predictor Of Valve Surmentioning

confidence: 99%

Decision Making in Asymptomatic Aortic Regurgitation in the Era of Guidelines

Kusunose

Agarwal

Marwick

et al. 2014

Circ: Cardiovascular Imaging

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Background-The decision-making role of exercise echocardiography in the surgical timing for aortic regurgitation remains a matter of debate because of limited data on its link with outcome. The aim of this study was to assess the role of echocardiographic measurements at rest and during exercise as predictors of valve surgery in asymptomatic aortic regurgitation. Methods and Results-Comprehensive resting and exercise echocardiography was performed in 159 consecutive patients (50±15 years; 80% male) with isolated moderately severe to severe aortic regurgitation and preserved left ventricular (LV) function (LV ejection fraction >50%, LV end-diastolic dimension ≤70 mm, LV end-systolic dimension ≤50 mm or ≤25 mm/m 2 ) in whom initial management was expectant. Echocardiographic measurements were performed at rest and during exercise. LV and right ventricular (RV) longitudinal strain was analyzed at rest using velocity vector imaging. Valve surgery was performed in 50 patients (31%) during 30±21 months. After adjustment for age and sex in a multivariable Cox proportional-hazards model, exercise tricuspid annular plane systolic excursion (TAPSE; hazards ratio [HR], 0.48; P=0.001) was associated with valve surgery-free, independent of resting LV strain (HR, 1.63; P=0.005), exercise LV end-diastolic volume (HR, 1.38; P=0.048), and resting RV strain (HR, 1.69; P=0.002 Kusunose et al Exercise Cardiac Dysfunction in AR 353identify the independent and incremental value of LV and RV function at rest and during exercise in predicting future surgical intervention in patients with asymptomatic AR without the need (ie, without class I or IIa indication) for surgery, but with the need for at least annual echocardiographic follow-up. Methods Study SampleBetween January 2006 and January 2012, consecutive asymptomatic patients with moderately severe to severe AR (vena contracta≥0.3 cm and effective regurgitant orifice [ERO] area≥20 mm, 2 regurgitant fraction≥40%, or regurgitant volume≥45mL) 14 were referred for exercise stress echocardiography at the Cleveland Clinic for the assessment of functional impact of AR. Clinical variables were prospectively gathered from the patients and their medical records at the time of the exercise echocardiogram. We selected patients with preserved LV systolic function (LVEF>50%, LV end-diastolic diameter≤70 mm, LV end-systolic diameter≤50 mm, and LV end-systolic diameter/body surface area≤25 mm/m 2 ). Based on an assumed rate of aortic valve surgery of ≈30% during a follow-up period, we anticipated 160 patients would be needed to develop a stable statistical model with 5 predictor variables. 15 The protocol was approved by the Cleveland Clinic Institutional Review Board. Echocardiographic Assessment at Rest and After ExerciseTransthoracic echocardiography was performed by experienced sonographers before and after symptom-limited exercise using a commercially available ultrasound machine (Vivid 7 or Vivid 9, GE Vingmed, Horten, Norway, Sonos 5500 or iE33, Philips, Andover, MA). All patients underwent...

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Preoperative Systolic Strain Rate Predicts Postoperative Left Ventricular Dysfunction in Patients With Chronic Aortic Regurgitation

Abstract: Background-The best predictor for postoperative left ventricular (LV) systolic dysfunction in patients with chronic aortic regurgitation is still a matter of debate.

Cited by 44 publications

References 39 publications

Myocardial Deformation Imaging

Myocardial Deformation Imaging

Echocardiographic Assessment of Myocardial Strain

Decision Making in Asymptomatic Aortic Regurgitation in the Era of Guidelines

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