Increased apical rotation in patients with severe aortic stenosis assessed by three-dimensional speckle tracking imaging

Tumenbayar, Maidar; Yamaguchi, Kazuto; Endo, Akira; Tanabe, Kazuaki

doi:10.1007/s12574-017-0347-3

Cited by 8 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Changes in LV rotation have been observed at the early phase of many cardiac diseases, and they even precede changes in longitudinal and circumferential strain (18). Aging, hypertension, hypertrophic cardiomyopathy and aortic stenosis are all characterized by increased apical rotation and delayed rotation with longer untwisting (18)(19)(20)(21)(22). Anthracycline treatment has induced a decline in both apical and basal rotation along with an overall twist becoming declined and delayed (23).…”

Section: Changes In Apical Strain In the Follow-up According To Brementioning

confidence: 99%

Left Ventricular Speckle Tracking Echocardiography Changes Among Early-stage Breast Cancer Patients Three Years After Radiotherapy

et al. 2019

View full text Add to dashboard Cite

Background/Aim: Chest radiotherapy (RT) doubles late cardiac mortality. This study aimed to evaluate the evolution of cardiac changes in speckle tracking echocardiography during a three-year follow-up. Materials and Methods: This prospective study included 81 chemotherapy-naïve early-stage breast cancer patients who were evaluated at baseline, immediately after RT and three years after RT. Sixty-one patients had left-sided (LSBC) and 20 right-sided breast cancer (RSBC). Results: Global longitudinal strain (GLS) declined from baseline-18.0±3.3% to-17.0±3.0% (p=0.015) at the three-year follow-up examination. A decline over 15% (GLS15) was observed in 19 (27%) patients. GLS15 was independently associated with aromatase inhibitor use (β=-1.977, p=0.001). In regional analysis, patients with LSBC had apical strain decline by 3.2±5.5% (p<0.001) and patients with RSBC showed basal rotation decline by 1.8˚ (-0.2˚, 3.8˚) (p=0.030). Conclusion: Even contemporary RT induced progressive global and regional decline in speckle tracking analysis. The regional changes complied with RT fields. Radiotherapy (RT) is an integral part of the treatment in half of cancer patients (1). Over 80% of early-stage breast cancer patients receive adjuvant RT, which reduces the local recurrence risk by half and, the late breast cancer-related mortality by a fifth. The overall survival of early-stage breast cancer patients at 5 years is 91% in Finland (www.cancerregistry.fi). However, RT induces adverse effects in healthy tissue, which may lead to late dysfunction in adjacent organs. The heart is an important organ at risk, especially in left-sided breast cancer (LSBC). Breast cancer RT increases cardiac mortality and morbidity almost twofold in long-term cohorts collected from patients treated with older RT techniques (2, 3). The modern RT treatment protocols have reduced cardiac radiation exposure. However, the clinical impact of the reduced cardiac dose will not be revealed until long-term data are available. In the meantime, early and mid-term cardiac changes are valuable in predicting later sequelae and to reveal the mechanism and time-course of RT-induced heart disease (RIDH). RIHD can manifest as coronary artery disease, valvular lesions, heart failure, pericardial changes or conduction abnormalities. These changes occur usually several years or decades after RT treatment (2-4). The early subclinical RTinduced cardiac changes precede the late manifestations. Perfusion defects and changes in strain and strain rate corresponding to the RT fields have been detected 0-6 months after RT with myocardial perfusion imaging and with echocardiography (5-7). After chemotherapy, an early change in global longitudinal strain (GLS) predicts later decline in left ventricular ejection fraction (LVEF), but the knowledge of post-RT strain evolution is sparse (8, 9). The aim of our study was to explore the evolution of early RT-induced changes in speckle tracking echocardiography (STE) in early-stage breast cancer patients within the first three years after ...

show abstract

Section: Changes In Apical Strain In the Follow-up According To Brementioning

confidence: 99%

Left Ventricular Speckle Tracking Echocardiography Changes Among Early-stage Breast Cancer Patients Three Years After Radiotherapy

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Several studies have shown that rotation and twist is higher in patients with more severe AS 19,20,30 . Using 2D STE, Holmes et al.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that rotation and twist is higher in patients with more severe AS. 19,20,30 Using 2D STE, Holmes et al found increased apical rotation to be associated with poor survival in severe AS, suggesting apical rotation as a compensatory mechanism to preserve cardiac output in severe LV outflow obstruction. 19 In the present study, only basal rotation was higher in the severe AS group.…”

Section: Discussionmentioning

confidence: 99%

“…3D STE, on the other hand, has better accuracy, reproducibility, and may overcome the limitations of 2D STE 18 . In patients with AS, a few smaller studies using 2D and 3D echocardiography have shown increased apical rotation in severe AS 19–21 . However, there is still limited knowledge from 3D STE on how AS severity impacts myocardial deformation in different LV levels.…”

Section: Introductionmentioning

confidence: 99%

“…18 In patients with AS, a few smaller studies using 2D and 3D echocardiography have shown increased apical rotation in severe AS. [19][20][21] However, there is still limited knowledge from 3D STE on how AS severity impacts myocardial deformation in different LV levels. Accordingly, the present study aims to explore the impact of AS severity on strain and twist measurements in different levels of the LV using 3D STE.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of aortic valve stenosis on myocardial deformation in different left ventricular levels: A three‐dimensional speckle tracking echocardiography study

et al. 2023

View full text Add to dashboard Cite

BackgroundGlobal systolic left ventricular (LV) myocardial function progressively declines as degenerative aortic valve stenosis (AS) progresses. Whether this results in uniformly distributed deformation changes from base to apex has not been investigated.MethodsEighty‐five AS patients underwent three‐dimensional (3D) echocardiography in this cross‐sectional study. Patients were grouped by peak jet velocity into mild (n = 32), moderate (n = 31), and severe (n = 22) AS. 3D speckle tracking derived strain, rotation, twist, and torsion were obtained to assess global LV function and myocardial function at the apical, mid, and basal levels.ResultsGlobal longitudinal strain (GLS) was lower in patients with severe AS (‐16.1 ± 2.4% in mild, ‐15.5 ± 2.5% in moderate, and ‐13.5 ± 3.0% in severe AS [all p < .01]). Peak basal and mid longitudinal strain (LS), basal rotation and twist from apical to basal level followed the same pattern, while peak apical LS was higher in moderate AS compared to severe AS (all p < .05). In multivariate analyses, lower GLS was particularly associated with male sex, higher body mass index and peak aortic jet velocity, lower basal LS with higher filling pressure (E/e’) and LV mass, lower mid LS with higher RWT and presence of AS symptoms, and lower apical LS with male sex and higher systolic blood pressure, respectively (all p < .05).ConclusionUsing 3D speckle tracking echocardiography reveals regional and global changes in LV mechanics in AS related to the severity of AS, LV remodeling and presence of cardiovascular risk factors.

show abstract

Clinical application of stress echocardiography for valvular heart disease

Kusunose

2019

J Med Ultrasonics

View full text Add to dashboard Cite

Valvular heart diseases (VHDs) constitute an increasing problem both as a consequence of population aging and as the sequelae of other heart diseases. Accurate diagnosis is essential for correct clinical decision -making; however, in many patients, transthoracic and transesophageal echocardiography is insufficient. Stress echocardiography (SE) proved to be a useful tool allowing for simultaneous assessment of left ventricular contractile reserve and HVD hemodynamics under conditions of physiological or pharmacological stress. It is recommended for assessing the severity of VHD, guiding the choice of treatment, as well as for surgical risk stratification. It can be applied both in asymptomatic patients with severe VHD and in symptomatic individuals with moderate disease. In patients with VHD, SE can be performed either as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE). The first modality is recommended to unmask symptoms or abnormal blood pressure response in patients with aortic stenosis (AS) who report to be asymptomatic or in those with mitral stenosis with discordance between clinical symptoms and the severity of valve disease on transthoracic echocardiography. In asymptomatic patients with paradoxical low -flow, low -gradient (LFLG) AS, ESE can be used to assess the severity of stenosis. On the other hand, low -dose DSE can be a useful diagnostic tool in classical LFLG AS, providing information on stenosis severity and contractile reserve. Moreover, SE is indicated in patients with prosthetic valve when there is discordance between symptoms and echocardiographic findings. It is also recommended in high -risk surgical patients with VHD with poor functional capacity and more than 2 clinical risk factors. The present paper discusses in detail the use of SE in VHD.

show abstract

Increased apical rotation in patients with severe aortic stenosis assessed by three-dimensional speckle tracking imaging

Abstract: In severe AS patients, impaired GLS existed although LVEF was preserved. However, LV rotation was increased in patients with severe AS probably to maintain the LV stroke volume.

Cited by 8 publications

References 23 publications

Left Ventricular Speckle Tracking Echocardiography Changes Among Early-stage Breast Cancer Patients Three Years After Radiotherapy

Left Ventricular Speckle Tracking Echocardiography Changes Among Early-stage Breast Cancer Patients Three Years After Radiotherapy

Impact of aortic valve stenosis on myocardial deformation in different left ventricular levels: A three‐dimensional speckle tracking echocardiography study

Clinical application of stress echocardiography for valvular heart disease

Contact Info

Product

Resources

About