Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis

Lafitte, Stéphane; Perlant, Matthieu; Réant, Patricia; Serri, Karim; Douard, H.; DeMaria, Anthony N.; Roudaut, R.

doi:10.1093/ejechocard/jen299

Cited by 186 publications

(160 citation statements)

References 19 publications

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“…In patients with asymptomatic AS, impaired subendocardial function has been shown to be associated with impaired exercise tolerance and changes in symptomatic status during short-term follow-up. 6,22 Our results have extended these preliminary data by showing that the decrease in long-axis function can identify a subset of patients with moderate to severe asymptomatic AS at greater risk of developing cardiac events.…”

supporting

confidence: 70%

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Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

Lancellotti¹,

Moonen²,

Magné³

et al. 2010

The American Journal of Cardiology

130

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In aortic stenosis (AS), the increased afterload results in progressive structural and functional changes that precede the development of symptoms. We hypothesized that the detection of abnormalities in left ventricular long-axis function could identify patients with asymptomatic AS at increased risk of events. We prospectively examined the outcome of 126 patients with asymptomatic AS who underwent a comprehensive echocardiographic examination, including tissue Doppler imaging. B-type natriuretic peptide ( Aortic valve stenosis (AS) is the most common valvular disease and has become the most common cardiovascular disease, after coronary artery disease and hypertension, in developed countries. 1 AS is characterized by a long asymptomatic phase, lasting several decades, during which outflow obstruction progressively develops. 2 Aortic valve replacement is the sole effective therapy for symptomatic patients. In contrast, the management of asymptomatic AS remains controversial. 3,4 In these patients, the chronically increased afterload results in progressive left ventricular (LV) myocardial hypertrophy and interstitial fibrosis, diastolic dysfunction, elevated left atrial pressures, dilation of the left atrium, and, eventually, intrinsic myocardial dysfunction. 5 These structural and functional changes precede symptom development, predict changes in clinical status, and trigger B-type natriuretic peptide (BNP) release. 6,7 In AS, the BNP level correlates with the valve area, diastolic function, functional status, and symptomatic deterioration and might improve risk stratification. 8 -11 Tissue Doppler measurement of mitral annular velocities is a sensitive method for the detection of early abnormalities in LV longaxis function and improves the assessment of LV diastolic function. 12 In asymptomatic AS, the incremental prognostic value of tissue Doppler imaging and BNP measurement compared with validated parameters has never been investigated. The present study was undertaken to prospectively assess the comparative usefulness in predicting the clinical outcomes of long-axis function and BNP level in a series of patients with asymptomatic severe AS. MethodsAsymptomatic patients with severe AS were prospectively screened from our echocardiographic laboratory for inclusion in the present study. All the patients met the following criteria: (1) moderate to severe AS, as defined by an aortic valve area of Յ1.2 cm 2 ; (2) no symptoms according to a careful history taken by the referring physician; (3) normal LV ejection fraction (Ն55%), as calculated by 2-dimensional echocardiography; (4) no more than mild associated cardiac valve lesions; (5) sinus rhythm; and (6) serum creatinine Ͻ16 mg/L. A total of 126 patients met these criteria. The relevant institutional review boards approved the protocol, and all patients gave written informed consent.A comprehensive Doppler echocardiographic study, including M-mode, 2-dimensional echocardiography, color Doppler, and pulsed-wave and continuous-wave Doppler measurements was perform...

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supporting

confidence: 70%

“…21 Despite appropriate hypertrophy and accumulation of collagen in the subendocardial region, the LV ejection fraction can be classically maintained within the normal range for years. 22 This reflects the preserved contribution of radial thickening to LV function. In contrast, the LV longitudinal function will be impaired because of subendocardial dysfunction.…”

mentioning

confidence: 95%

Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

Lancellotti¹,

Moonen²,

Magné³

et al. 2010

The American Journal of Cardiology

130

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“…[16][17][18] Furthermore, these parameters have been shown to be superior to LVEF to predict adverse outcomes in AS. [16][17][18][19][20] From a pathophysiological standpoint, these data are consistent with the concept that the increase in wall stress and intra-myocardial pressure as well as the reduction in M A N U S C R I P T…”

Section: Amount and Distribution Of Adiposity Versus LV Systolic Dysfsupporting

confidence: 87%

Visceral Adiposity and Left Ventricular Mass and Function in Patients With Aortic Stenosis: The PROGRESSA Study

Capoulade

Larose

Mathieu

et al. 2014

Canadian Journal of Cardiology

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Brief SummaryThe purpose of this study was to examine the association between amount and distribution of body fat and LV hypertrophy and systolic dysfunction in aortic stenosis (AS) patients. The increased total adiposity as well as a high proportion of visceral adipose tissue (VAT) are both associated with LV hypertrophy, independent of AS severity and hypertension. The excess VAT and a high proportion of VAT relative to total adipose tissue are independently associated with impaired LV systolic function in AS. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 3 ABSTRACTBackground: Recent studies have reported that obesity, metabolic syndrome, and diabetes are

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“…Lafitte et.al. estudiaron a 65 pacientes asintomáticos con EA severa demostrando que estos presentaban valores más bajos de GLS respecto a los controles, la diferencia es más pronunciada en los segmentos basales (Lafitte et al 2009). Tal vez el estudio de Weidemann et.al., sea el que ponga más de manifiesto la utilidad del strain, estos autores estudiaron a 58 pacientes con EA severa sintomática sin otras cardiopatías concomitantes, les realizaron ecocardiograma y resonancia magnética cardíaca (RMC) antes de la cirugía determinando el strain longitudinal y el realce tardío de gadolinio como marcador de fibrosis.…”

Section: Aplicaciones Del Análisis De Defor-mación Miocárdicaunclassified

Ecocardiografía avanzada: aplicación clínica actual del análisis de deformación miocárdica y de la imagen tridimensional

Recalde

2017

REMCB

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Artículo de revisión MECÁNICA CARDÍACA: ANÁLISIS DE DE-FORMACIÓN MIOCÁRDICAEn los últimos años se ha puesto de manifiesto la necesidad de trasladar el momento del diagnóstico de las enfermedades cardiovasculares hacia estadios precoces e identificar los pacientes con mínimos cambios estructurales y mayores probabilidades de remodelado inverso. Para hacer realidad este objetivo se necesita un parámetro capaz de detectar los cambios sutiles que se producen en el inicio de la enfermedad.En la actualidad la determinación de la fracción de eyección del ventrículo izquierdo (FEVI) es el método utilizado para medir la función sistólica, y aunque existe gran cantidad de literatura que respalda esta estrategia, hay varias limitaciones en la práctica diaria; por ejemplo, las técnicas empleadas para calcular la FEVI utilizan fórmulas con asunciones geométricas que no siempre son aplicables y sus resultados son muy susceptibles a cambios en la precarga, asimismo, la frecuencia cardíaca y las alteraciones del ritmo pueden dificultar mucho su interpretación (Marwick 2012). Al hablar de contractilidad regional el escenario se complica aún más. La correcta identificación de asimetrías regionales requiere un proceso de entrenamiento específico, así como la adquisición de experiencia, ya que este análisis es cualitativo, subjetivo y, como toda téc-nica ecocardiográfica, dependiente de la calidad de imagen disponible.Por todo esto es que la disponibilidad de una técni-ca para medir la función sistólica, como el análisis de deformación miocárdica, que sea cuantitativa, reproducible y fiable, supondría un avance considerable en la capacidad diagnóstica de la ecocardiografía actual. Para comprender este enfoque es necesario repasar dos conceptos: la arquitectura del ventrículo izquierdo y la transmuralidad de la enfermedad.Arquitectura del ventrículo izquierdo.-El conocimiento de la estructura miocárdica del ventrículo izquierdo (VI) es fundamental para comprender el estudio de la deformación, así como para optimizar el análisis de los parámetros de medición (Mor-Avi et al. 2011). Se ha descrito que los miocitos se encuentran dispuestos de manera que forman dos hélices continuas de fibras, pasando de una hélice orientada hacia la derecha en el subendocardio a una hélice orientada hacia la izquierda en el subepicardio, lo que ocasiona que el eje longitudinal de las fibras rote continuamente, y por consiguiente, sea distinto en cada capa de miocardio: longitudinal (respecto al eje del VI) en el subendocardio, circunferencial en el mesocardio y oblicua en el subepicardio (Sengupta et al. 2006). Esta distribución determina como cada región contribuye a la mecánica miocár-dica, por ejemplo, la deformación longitudinal se da gracias a las fibras subendocárdicas. El análisis de la deformación de las fibras según su orientación ha permitido definir los patrones de mecánica longitudinal, circunferencial, radial y de torsión (Opdahl et al. 2015).

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Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis

Abstract: In asymptomatic patients with severe AS, impaired longitudinal contraction assessed by 2D strain is associated with abnormal exercise response and with an increased risk of cardiac events during follow-up.

Cited by 186 publications

References 19 publications

Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

Visceral Adiposity and Left Ventricular Mass and Function in Patients With Aortic Stenosis: The PROGRESSA Study

Ecocardiografía avanzada: aplicación clínica actual del análisis de deformación miocárdica y de la imagen tridimensional

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