Impact of aortic stenosis on longitudinal myocardial deformation during exercise

Donal, Erwan; Thébault, Christophe; O’Connor, Kim; Veillard, D.; Roşca, Monica; Piérard, Luc; Lancellotti, Patrizio

doi:10.1093/ejechocard/jeq187

Cited by 90 publications

(70 citation statements)

References 32 publications

(32 reference statements)

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“…At the same time, the authors observed the improvement of GLS values three months after aortic valve replacement surgery. These observations are not confirmed by Donal et al [4]. In the study by Delgado et al [6], patients with severe AS had significantly lower GLS compared to patients with hypertension with a similar degree of LV hypertrophy.…”

Section: Discussionmentioning

confidence: 77%

“…The usefulness of this parameter in detecting subtle changes in LV function secondary to various pathologies and their prognostic significance was shown also in AS [6][7][8]. Still little is known about the importance of exercise-induced changes in GLS in patients with high-gradient asymptomatic severe AS [4,5,9,10].…”

Section: Introductionmentioning

confidence: 98%

“…Surgical treatment is clearly advisable in symptomatic patients. The management of asymptomatic patients is still under discussion [3][4][5]. Left ventricular ejection fraction (LVEF) below 50% is an indication for surgical treatment [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

“…The management of asymptomatic patients is still under discussion [3][4][5]. Left ventricular ejection fraction (LVEF) below 50% is an indication for surgical treatment [2,4,5]. However, LVEF is reduced at a late stage, and it is caused by various mechanisms related to left ventricular (LV) structural changes (hypertrophy, proliferation of connective tissue elements, afterload mismatch).…”

Section: Introductionmentioning

confidence: 99%

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Exercise-induced changes in left ventricular global longitudinal strain in asymptomatic severe aortic stenosis

et al. 2017

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A b s t r a c t Background:The management of patients with asymptomatic severe aortic stenosis (ASAS) is still under discussion. Therefore, it is advisable to search for the parameters of early damage to left ventricular (LV) function. Aim:The aim of the study was to assess exercise-induced changes in LV global longitudinal strain (GLS) in ASAS. Methods:The ASAS group consisted of 50 patients (26 women and 24 men, aged 38.4 ± 18.1 years) meeting the echocardiographic criteria of severe aortic stenosis (AVA < 1 cm 2 , AVAI < 0.6 cm 2 /m 2 , Vmax > 4 m/s, mean aortic gradient > 40 mm Hg), with normal LV ejection fraction (LVEF ≥ 55%) and sinus rhythm on electrocardiogram, and without significant concomitant valvular heart diseases. The control group consisted of 21 people matched for age and sex. Echocardiographic examinations and echocardiographic stress tests with the assessment of GLS using the speckle tracking imaging were performed. Results:The ASAS group was characterised by statistically significantly higher LV mass index (LVMI) and higher LVEF. GLS values at rest in both groups were within normal limits but were significantly higher in the control group (-18.9 ± 2.4% vs. -20.7 ± 1.7%, p = 0.006). An increase in GLS at peak exercise in both groups was observed, lower in the ASAS group (the difference was not statistically significant: -0.8 ± 3.0% vs. -2.2 ± 3.1%, p = 0.086). Changes in GLS during exercise (∆GLS) did not correlate with the parameters of the severity of aortic stenosis. In the multivariate model, LVMI proved to be a factor associated with GLS at rest and during exercise. Conclusions:In patients with ASAS, GLS is a non-invasive marker of an early stage of LV myocardial damage associated with myocardial hypertrophy. An increase in GLS during exercise in the ASAS group, smaller than in the control group, indicates a preserved functional reserve of the LV myocardium but smaller than in healthy individuals. The assessment of the clinical usefulness of exercise-induced changes in GLS requires further research.

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exercise-induced changes in left ventricular global longitudinal strain in asymptomatic severe aortic stenosis

et al. 2017

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“…Une amélioration < −1,4 % du strain longitudinal global a été également corrélée à un risque élevé de réponse anormale à l'exercice dans le travail de Donal et al [24].…”

Section: Fonction Longitudinaleunclassified

Sténose aortique sévère asymptomatique à fraction d’éjection ventriculaire gauche préservée. Évaluation à l’effort : quels résultats et quelles décisions ?

Bensahi

Elfhal

Magné

et al. 2015

Annales de Cardiologie et d'Angéiologie

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Exercise echocardiography in valve disease

Ilardi

Sugimoto

Dulgheru

et al. 2017

Continuing Cardiol Educ

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Evidence supporting the use of exercise echocardiography to identify the true hemodynamic consequences of valvular heart disease (VHD) is progressively accumulating. From a clinical standpoint, the evaluation of VHD limited to resting conditions often underestimates the full clinical impact of the lesion. Exercise echocardiography has proved to be an important clinical tool in the risk stratification and the decision making of patients with VHD. It is very useful in case of discrepancy between symptoms and severity of valve lesion. Moreover, the evaluation of dynamic components of VHD, ventricular function, and exercise capacity provides clinician additive prognostic value that can be really helpful in the management planning of these patients.

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Impact of aortic stenosis on longitudinal myocardial deformation during exercise

Abstract: In AS, subnormal LV function can be reliably identified by 2D strain imaging at rest and during a sub-maximal exercise. That sensitive measure of LV systolic function is depressed in AS and even more in patients having the most severe AS.

Cited by 90 publications

References 32 publications

Exercise-induced changes in left ventricular global longitudinal strain in asymptomatic severe aortic stenosis

Exercise-induced changes in left ventricular global longitudinal strain in asymptomatic severe aortic stenosis

Sténose aortique sévère asymptomatique à fraction d’éjection ventriculaire gauche préservée. Évaluation à l’effort : quels résultats et quelles décisions ?

Exercise echocardiography in valve disease

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