Alteration in Subendocardial and Subepicardial Myocardial Strain in Patients with Aortic Valve Stenosis: An Early Marker of Left Ventricular Dysfunction?

Symptoms in Severe Aortic Stenosis are Associated with Decreased Compensatory Circumferential Myocardial Mechanics

“…22 In a study using three-dimensional echocardiographic strain analysis measuring radial and longitudinal strain, in a subgroup of patients with severe AS (only 12% were symptomatic), global radial strain remained normal. 23 In view of low longitudinal strain, circumferential strain needs to be higher than normal to maintain normal radial strain. Thus, normal circumferential strain and rotation in a patient with severe AS are likely to be actually abnormal, suggesting that compensation may already be failing.…”

Impact of Classic and Paradoxical Low Flow on Survival After Aortic Valve Replacement for Severe Aortic Stenosis

“…Conversely, reduced SVi and PLF groups were independently associated with 30-day mortality but not with late mortality (Central Illustration). Although several of the features of PLF (e.g., pronounced LV concentric remodeling and/or hypertrophy, moderate to severe diastolic dysfunction, decreased longitudinal strain,and reduced SVi) are associated with increased operative mortality, they often improve within the weeks or months following a successful surgical or transcatheter AVR(18)(19)(20)(21)(22). This may explain the fact that PLF has no impact on late postoperative mortality.Low pre-procedural SVi has been shown to be an independent predictor of procedural and/or 2-year mortality after transcatheter AVR, whereas low LVEF was not(2,3).…”

Newer echocardiographic techniques for aortic-valve imaging: Clinical aids today, clinical practice tomorrow

“…Impaired endocardial radial strain is observed in patients with AS and preserved LVEF and correlates with AS severity; epicardial radial strain is, however, preserved[35]. Hyodo et al[36] suggested the use of a novel parameter called the bilayer ratio (subendocardial to subepicardial strain ratio), the value of which decreases as the severity of AS increases given the decrease in subendocardial thickness due to ischemia and compensatory increase in subepicardial thickness. This was deemed to be superior to longitudinal strain, which only takes the subendocardium into account.…”

“…Several studies have reported reverse remodeling (improvement in strain parameters) in the minutes, 72 h, and month following TAVR[36,62-64]. In a prospective study, Swan et al[65] demonstrated immediate improvement (within minutes) in circumferential and radial strain following TAVR.…”