Assessment of left ventricular function in aortic stenosis

Özkan, Adem; Kapadia, Samir; Tuzcu, Murat; Marwick, Thomas H.

doi:10.1038/nrcardio.2011.80

Cited by 49 publications

(40 citation statements)

References 71 publications

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“…Although LV ejection fraction (LVEF) is the most commonly used method to assess myocardial function, it is not a sensitive measure of systolic dysfunction in AS. 10 In contrast, myocardial strain is a measure of myocardial deformation, which represents an index of contractility, 10,11 and has been shown to be impaired in AS despite normal LVEF. 11 Myocardial strain can be measured using noninvasive cardiovascular magnetic resonance (CMR) tagging.…”

Section: Editorial See P 614 Clinical Perspective On P 816mentioning

confidence: 99%

Myocardial Steatosis and Left Ventricular Contractile Dysfunction in Patients With Severe Aortic Stenosis

Mahmod

Bull

Suttie

et al. 2013

Circ: Cardiovascular Imaging

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Background-Aortic stenosis (AS) leads to left ventricular (LV) hypertrophy and dysfunction. We hypothesized that cardiac steatosis is involved in the pathophysiology and also assessed whether it is reversible after aortic valve replacement. Methods and Results-Thirty-nine patients with severe AS (symptomatic=25, asymptomatic=14) with normal LV ejection fraction and no significant coronary artery disease and 20 age-and sex-matched healthy controls underwent cardiac 1H-magnetic resonance spectroscopy and imaging for the determination of steatosis (myocardial triglyceride content) and cardiac function, including circumferential strain (measured by magnetic resonance tagging). Strain was lower in both symptomatic and asymptomatic AS (−16.4±2.5% and −18.1±2.9%, respectively, versus controls −20.7±2.0%, both P<0.05). Myocardial steatosis was found in both symptomatic and asymptomatic patients with AS (0.89±0.42% in symptomatic AS; 0.75±0.36% in asymptomatic AS versus controls 0.45±0.17, both P<0.05). Importantly, multivariable analysis indicated that steatosis was an independent correlate of impaired LV strain. Spectroscopic measurements of myocardial triglyceride content correlated significantly with histological analysis of biopsies obtained during aortic valve replacement. At 8.0±2.1 months after aortic valve replacement, steatosis and strain had recovered toward normal. Conclusions-Pronounced myocardial steatosis is present in severe AS, regardless of symptoms, and is independently associated with the degree of LV strain impairment. Myocardial triglyceride content measured by magnetic resonance spectroscopy correlates with histological quantification. Steatosis and strain impairment are reversible after aortic valve replacement. Our findings suggest a novel pathophysiological mechanism in AS, myocardial steatosis, which may be amenable to treatment, thus potentially delaying onset of LV dysfunction.

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Section: Editorial See P 614 Clinical Perspective On P 816mentioning

confidence: 99%

Myocardial Steatosis and Left Ventricular Contractile Dysfunction in Patients With Severe Aortic Stenosis

Mahmod

Bull

Suttie

et al. 2013

Circ: Cardiovascular Imaging

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“…Assessment of myocardial deformation parameters provides superior quantification of systolic function, with increased sensitivity to subtle myocardial dysfunction than global LVEF (12) and holds prognostic value in patients with AS (13) even when asymptomatic (14). Cardiovascular magnetic resonance (CMR) tagging is accepted by many as the gold standard for measurement of circumferential and longitudinal myocardial strain (15,16) and has good demonstrated reproducibility (17).…”

Section: Introductionmentioning

confidence: 99%

Myocardial strain and symptom severity in severe aortic stenosis: insights from cardiovascular magnetic resonance

Musa¹,

Uddin²,

Swoboda³

et al. 2017

Quant. Imaging Med. Surg.

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Background: Symptomatic severe aortic stenosis (AS) is a class I indication for replacement in patients when left ventricular ejection fraction (LVEF) is preserved. However, symptom reporting is often equivocal and decision making can be challenging. We aimed to quantify myocardial deformation using cardiovascular magnetic resonance (CMR) in patients classified by symptom severity.Methods: Forty-two patients with severe AS referred to heart valve clinic were studied using tagged CMR imaging. All had preserved LVEF. Patients were grouped by symptoms as either "none/mild" (n=21, NYHA class I, II) or "significant" (n=21, NYHA class III, IV, angina, syncope) but were comparable for age (72.8±5.4 vs. 71.0±6.8 years old, P=0.345), surgical risk (EuroSCORE II: 1.90±1.7 vs. 1.31±0.4, P=0.302) and haemodynamics (peak aortic gradient: 55.1±20.8 vs. 50.4±15.6, P=0.450). Thirteen controls matched in age and LVEF were also studied. LV circumferential strain was calculated using inTag © software and longitudinal strain using feature tracking analysis.Results: Compared to healthy controls, patients with severe AS had significantly worse longitudinal and circumferential strain, regardless of symptom status. Patients with "significant" symptoms had significantly worse peak longitudinal systolic strain rates (−83.352±24.802%/s vs. −106.301±43.276%/s, P=0.048) than those with "no/mild" symptoms, with comparable peak longitudinal strain (PLS), peak circumferential strain and systolic and diastolic strain rates. Conclusions:Patients with severe AS who have no or only mild symptoms exhibit comparable reduction in circumferential and longitudinal fibre function to those with significant symptoms, in whom AVR is clearly indicated. Given these findings of equivalent subclinical dysfunction, reportedly borderline symptoms should be handled cautiously to avoid potentially adverse delays in intervention.

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“…A brief clockwise rotation of the apex and a counterclockwise rotation of the base occur just before systole as left ventricular pressure increases (known as isovolumetric contraction). This movement is followed by a sustained counterclockwise rotation of the apex and a clockwise rotation of the base during the ventricular ejection phase to essentially wring blood content from the left ventricle 2,12 ( Figure 3). Ventricular twist augments ejection of blood through the aortic valve and into the aorta and reduces myocardial oxygen demand.…”

Section: Normal Heart and Valve Functionmentioning

confidence: 99%

“…12 Closure of the mitral and tricuspid valves marks the onset of systole and produces a sound known as S 1 , best auscultated at the fifth intercostal space, left midclavicular line. Closure of the pulmonic and aortic valves marks the end of systole and produces a sound known as S 2 , best auscultated at the second intercostal space at the left or right sternal border.…”

Section: Normal Heart and Valve Functionmentioning

confidence: 99%

Aortic Stenosis: Pathophysiology, Diagnosis, and Medical Management of Nonsurgical Patients

Cary

Pearce²

2013

Critical Care Nurse

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A ortic stenosis is caused by narrowing of the orifice of the aortic valve and leads to obstruction of left ventricular outflow. This stenosis is rare in persons less than 50 years old.1 Calcification of the aortic valve is the most common cause of aortic stenosis in adults in industrialized countries and affects more than 4% of North American and Europeans more than 75 years old.2 In a study 3 of 338 North American patients with severe asymptomatic aortic stenosis, the mean age was 71 (SD, 15) years. Aortic stenosis was also associated with higher morbidity and mortality rates than were diseases involving other cardiac valves. 4 For example, in a study 5 of 161 patients, patients with moderate and

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Assessment of left ventricular function in aortic stenosis

Cited by 49 publications

References 71 publications

Myocardial Steatosis and Left Ventricular Contractile Dysfunction in Patients With Severe Aortic Stenosis

Myocardial Steatosis and Left Ventricular Contractile Dysfunction in Patients With Severe Aortic Stenosis

Myocardial strain and symptom severity in severe aortic stenosis: insights from cardiovascular magnetic resonance

Aortic Stenosis: Pathophysiology, Diagnosis, and Medical Management of Nonsurgical Patients

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