Reduced Longitudinal Function in Chronic Aortic Regurgitation

Lavine, Steven J.; Balbissi, Kais Al

doi:10.4250/jcu.2015.23.4.219

Cited by 7 publications

(8 citation statements)

References 26 publications

(33 reference statements)

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“…Hence, the data suggest that the horses with moderate‐to‐severe AR included in this study still had preserved LV systolic function. In humans, depending on the chronicity and severity of disease, the remodeling process is a continuum, with concentric hypertrophy of the LV seen with patients that have AR with a preserved LV ejection fraction (LVEF) whereas eccentric hypertrophy was found in patients that have reduced LVEF 44. When classified on the basis of severity of regurgitation, no difference in LV systolic or diastolic TDI variables is detected between groups of people with moderate or severe AR, whereas classification based on LVEF (preserved or reduced) shows marked differences in TDI variables between the two groups 44.…”

Section: Discussionmentioning

confidence: 99%

“…In humans, depending on the chronicity and severity of disease, the remodeling process is a continuum, with concentric hypertrophy of the LV seen with patients that have AR with a preserved LV ejection fraction (LVEF) whereas eccentric hypertrophy was found in patients that have reduced LVEF 44. When classified on the basis of severity of regurgitation, no difference in LV systolic or diastolic TDI variables is detected between groups of people with moderate or severe AR, whereas classification based on LVEF (preserved or reduced) shows marked differences in TDI variables between the two groups 44. Throughout the remodeling process, the degree of LV systolic and diastolic function may change with respect to relaxation, compliance, and recoil in response to changing wall thickness, LV volume, filling pressures, and other factors.…”

Section: Discussionmentioning

confidence: 99%

“…variables between the two groups. 44 Throughout the remodeling process, the degree of LV systolic and diastolic function may change with respect to relaxation, compliance, and recoil in response to changing wall thickness, LV volume, filling pressures, and other factors. While this is purely hypothetical, it might therefore be possible that the horses with moderate-to-severe AR included in this study were at a stage of LV remodeling that preserved LV function when assessed by TDI variables.…”

Section: Discussionmentioning

confidence: 99%

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Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed‐Wave Tissue Doppler Imaging

Koenig

Mitchell

Schwarzwald

2017

Veterinary Internal Medicne

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BackgroundAssessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease.ObjectivesTo describe the use of pulsed‐wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease.AnimalsThirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD.MethodsEchocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one‐way ANOVA and Dunnett's test.ResultsA complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ETm (−118.5 [−154.1 to −82.9] ms; mean difference [95% CI of difference of means]), increased PEPm/ETm (0.11 [0.05 to 0.17]), prolonged IMPm (0.28 [0.18 to 0.37]), increased S 1 (8.9 [5.2 to 12.6] cm/s), and decreased E 1 (−2.6 [−4.7 to −0.5] cm/s), E m (−14.2 [−19.9 to −8.5] cm/s), and E m/A m ratio (−1.6 [−2.6 to −0.6]).Conclusions and Clinical ImportancePulsed‐wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed‐Wave Tissue Doppler Imaging

Koenig

Mitchell

Schwarzwald

2017

Veterinary Internal Medicne

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“…; Adda et al . ; Lavine & Al Balbissi, ). Nonetheless, marked overlap remained in longitudinal peak ԑ between these disease states and healthy control subjects, which is further limited by a single measurement of longitudinal peak ԑ not reflecting the temporal changes throughout the cardiac cycle.…”

Section: Introductionmentioning

confidence: 99%

Exploratory assessment of left ventricular strain–volume loops in severe aortic valve diseases

Hulshof¹,

Dijk²,

George

et al. 2017

The Journal of Physiology

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Key points summary 29• Severe aortic valve diseases represent common cardiac abnormalities that are associated 30 with poor long-term survival. 31• Prior to any reduction in left ventricular function, the left ventricle undergoes structural 32 remodeling under the influence of a changing haemodynamic conditions. 33• In this study, we combined temporal changes in LV structure (volume) to alterations in LV 34 functional characteristics (strain, ԑ) into a ԑ-volume loop, to provide novel insight into the 35 haemodynamic cardiac consequences of aortic valve diseases in those with preserved LV 36 ejection fraction. 37• We showed that our novel ԑ-volume loop and the specific loop characteristics provides 38 additional insight in the functional and mechanical haemodynamic consequences of severe 39 aortic valve diseases (with preserved LV ejection fraction). 40• Finally we showed that the ԑ-volume loop characteristics provide discriminative capacity 41 Methods. 27 participants were retrospectively recruited: AR (n=7), AS (n=10) and controls 48 (n=10). Standard transthoracic echocardiography was utilised to obtain apical 4 chamber 49 images to construct ԑ-volume relationships were assessed by: Early systolic ԑ (ԑ_ES), slope of 50 ԑ-volume relation during systole (Sslope), End-systolic peak ԑ (peak ԑ), Diastolic uncoupling 51 (systolic ԑ-diastolic ԑ at same volume) during early diastole (UNCOUP_ED) and late diastole 52 (UNCOUP_LD). ROC-curves were used to determine the ability to detect impaired LV 53 function. 54Results. Whilst LV ejection fraction was comparable between groups, longitudinal peak ԑ was 55 similarly reduced compared to controls. In contrast, ԑ_ES and Sslope were lower in both 56 pathologies compared to controls (P<0.01), but also different between AS and AR (P<0.05). 57 UNCOUP_ED as UNCOUP_LD were significantly higher in both patient groups compared to 58 controls (P<0.05). ROC-curves revealed that loop characteristics (AUC=0.99, 1.00, 1.00; all 59 P<0.01) were better able then peak ԑ (AUC=0. 75, 0.89, 0.76; P=0.06, <0.01 and 0.08, 60 respectively) and LV ejection fraction (AUC=0.56, 0.69, 0.69; all P>0.05) to distinguish AS vs 61 Controls, AR vs Controls and AS vs AR, respectively. 62

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“…LV global longitudinal strain (GLS) is significantly reduced in patients with severe AR and otherwise normal LVEF [ 92 , 93 ]. Several observational studies have demonstrated that GLS is an independent predictor of mortality in patients with severe AR [ 94 – 97 ]. A recently published systematic review reports that worse values of GLS are associated with poor cardiovascular outcomes [ 98 ].…”

Section: Echocardiographic Assessment Of Aortic Regurgitationmentioning

confidence: 99%

Echocardiographic assessment of aortic regurgitation: a narrative review

Tsampasian,

Victor,

Bhattacharyya

et al. 2024

Echo Res Pract

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Aortic regurgitation (AR) is the third most frequently encountered valve lesion and may be caused by abnormalities of the valve cusps or the aorta. Echocardiography is instrumental in the assessment of AR as it enables the delineation of valvular morphology, the mechanism of the lesion and the grading of severity. Severe AR has a major impact on the myocardium and carries a significant risk of morbidity and mortality if left untreated. Established and novel echocardiographic methods, such as global longitudinal strain and three-dimensional echocardiography, allow an estimation of this risk and provide invaluable information for patient management and prognosis. This narrative review summarises the epidemiology of AR, reviews current practices and recommendations with regards to the echocardiographic assessment of AR and outlines novel echocardiographic tools that may prove beneficial in patient assessment and management.

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Reduced Longitudinal Function in Chronic Aortic Regurgitation

Cited by 7 publications

References 26 publications

Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed‐Wave Tissue Doppler Imaging

Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed‐Wave Tissue Doppler Imaging

Exploratory assessment of left ventricular strain–volume loops in severe aortic valve diseases

Echocardiographic assessment of aortic regurgitation: a narrative review

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