EVALUATION OF THE LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN IN PATIENTS WITH SEVERE AORTIC STENOSIS THAT UNDERGO SURGICAL AORTIC VALVE REPALCEMENT: A CASE REPORT
Abstract
ABSTRACT
Introduction and goal: Degenerative aortic stenosis is the most common valvular disease for which treatment of choice is stil surgery. Without the presence of symptoms, evaluation of systolic function of the left ventricle (LV) is crucial in surgical treatment decision making. Global longitudinal strain (GLS) is a valuable marker for subclinical systolic dysfunction delivering promising conditions for the right timing of the surgical aortic valve replacement (SAVR).
Material and methods: We present a case of a 57-year old male with severe aortic stenosis. Detailed echocardiographic examination was performed including GLS of the LV with 2D speckle tracking before and after SAVR.
Results: The ejection fraction before and after the surgical treatment was normal. GLS before the surgical treatment was -15, 1%, for 3-chamber GLS the value was -15,3%; for 4-ch it was -14,2% and 2-ch counted -16%. After replacement of the aortic valve with mechanical prosthesis, the echocardiographic assessment done 4 months later showed improvement of the GLS values to -17,1% ( -18,5% for 3-ch, -15,0% for 4-ch and -17,1% for 2-ch).
Conclusion: Global longitudinal strain (GLS) of the LV is abnormal in patients with severe aortic stenosis. Surgical treatment of aortic stenosis improves GLS of the LV implicating improvement of the subclinical systolic dysfunction of the LV.
Key words: aortic valvular stenosis, longitudinal strain, systolic function, echocardiography
References
References
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3. Kearney LG, Lu K, Ord M, et al. Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2012;13(10):827-833. doi:10.1093/ehjci/jes115.
4. Nishimura RA, Otto CM. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.; 2017. doi:10.1161/CIR.0000000000000503.
5. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-2786. doi:10.1093/eurheartj/ehx391.
6. Cengiz B, Yurdakul S, Åžahin ÅžT, Kahraman S, Aytekin S. Subclinical Left Ventricular Systolic Dysfunction in Patients with Severe Aortic Stenosis: A Speckle Tracking and Real Time Three Dimensional Echocardiographic Study. J Am Coll Cardiol. 2013;62(18):C2-C3. doi:10.1016/j.jacc.2013.08.014.
7. Ng ACT, Delgado V, Bertini M, et al. Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: A two-dimensional speckle tracking analysis. Eur Heart J. 2011;32(12):1542-1550. doi:10.1093/eurheartj/ehr084.
8. Donal E, Thebault C, Oconnor K, et al. Impact of aortic stenosis on longitudinal myocardial deformation during exercise. Eur J Echocardiogr. 2011;12(3):235-241. doi:10.1093/ejechocard/jeq187.
9. Staron A, Bansal M, Kalakoti P, et al. Speckle tracking echocardiography derived 2-dimensional myocardial strain predicts left ventricular function and mass regression in aortic stenosis patients undergoing aortic valve replacement. Int J Cardiovasc Imaging. 2013;29(4):797-808. doi:10.1007/s10554-012-0160-z.
10. Marcus K a., De Korte CL, Feuth T, et al. Persistent reduction in left ventricular strain using two-dimensional speckle-tracking echocardiography after balloon valvuloplasty in children with congenital valvular aortic stenosis. J Am Soc Echocardiogr. 2012;25(5):473-485. doi:10.1016/j.echo.2012.01.009.
11. Yingchoncharoen T, Gibby C, Rodriguez LL, Grimm RA, Marwick TH. Association of myocardial deformation with outcome in asymptomatic aortic stenosis with normal ejection fraction. Circ Cardiovasc Imaging. 2012;5(6):719-725. doi:10.1161/CIRCIMAGING.112.977348.
12. Voigt JU, Pedrizzetti G, Lysyansky P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16(1):1-11. doi:10.1093/ehjci/jeu184.
13. Yingchoncharoen T, Agarwal S, Popovi ZB. Normal Ranges of Left Ventricular Strain : 2011:185-191. doi:10.1016/j.echo.2012.10.008.
14. Sugimoto T, Dulgheru R, Bernard A, et al. Echocardiographic reference ranges for normal left ventricular 2D strain: Results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2017;18(8):833-840. doi:10.1093/ehjci/jex140.
15. Kusunose K, Goodman A, Parikh R, et al. Incremental prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis and preserved ejection fraction. Circ Cardiovasc Imaging. 2014;7(6):938-945. doi:10.1161/CIRCIMAGING.114.002041.
16. Lafitte S, Perlant M, Reant P, et al. Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr. 2009;10(3):414-419. doi:10.1093/ejechocard/jen299.
17. Delgado V, Tops LF, Van Bommel RJ, et al. Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement. Eur Heart J. 2009;30(24):3037-3047. doi:10.1093/eurheartj/ehp351.
18. Poulsen SH, Søgaard P, Nielsen-Kudsk JE, Egeblad H. Recovery of Left Ventricular Systolic Longitudinal Strain After Valve Replacement in Aortic Stenosis and Relation to Natriuretic Peptides. J Am Soc Echocardiogr. 2007;20(7):877-884. doi:10.1016/j.echo.2006.11.020.
19. Călin A, Roşca M, Beladan CC, et al. The left ventricle in aortic stenosis – imaging assessment and clinical implications. Cardiovasc Ultrasound. 2015;13(1):22. doi:10.1186/s12947-015-0017-4.
20. Lancellotti P, Donal E, Magne J, et al. Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay. Heart. 2010;96(17):1364-1371. doi:10.1136/hrt.2009.190942.
21. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-271. doi:10.1093/ehjci/jev014.
22. Eacvi T, Comparison ASEI, Thomas JD, Farsalinos KE, Daraban AM, Unl S. Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors. J Am Soc Echocardiogr 2015. doi:10.1016/j.echo.2015.06.011.
23. Mirea O, Pagourelias ED, Unl S, Thomas JD, Badano LP, Voigt J. Comparison of Feasibility , Accuracy , and Reproducibility of Layer-Specific Global Longitudinal Strain Measurements Among Five Different Vendors: A Report from the EACVI-ASE Strain Standardization Task Force. J Am Soc Echocardiogr 2018;31:374-381. doi:10.1016/j.echo.2017.11.008.
24. Takigiku K, Takeuchi M, Izumi C, et al. Inter-Vendor Variability for Measurements of Left Ventricular Strain Using Two-Dimensional Speckle Tracking Analysis : A Substudy of Japanese Ultrasound Speckle Tracking of the Left Ventricle ( JUSTICE ) Results Inter-vender agreement : Linear correlation. http://spo.escardio.org/eslides/view.aspx?eevtid=54&fp=P4863 Accеssed October 2018
25. Everett RJ, Clavel M, Pibarot P, Dweck MR, Everett RJ. Timing of intervention in aortic stenosis : a review of current and future strategies. 2018:1-11. doi:10.1136/heartjnl-2017-312304.
26. Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis : A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Hear J Cardiovasc Imaging 2017;18:254-75.
27. Potter E, Marwick TH. Assessment of Left Ventricular Function by Echocardiography. JACC Cardiovasc Imaging 2018;11(2 Pt1):260-74. doi:10.1016/j.jcmg.2017.11.017.
28. Carasso S, Mutlak D, Lessick J, Reisner SA, Rakowski H, Agmon Y. Symptoms in severe aortic stenosis are associated with decreased compensatory circumferential myocardial mechanics. J Am Soc Echocardiogr. 2015;28(2):218-225. doi:10.1016/j.echo.2014.09.006.
29. Galli E, Lancellotti P, Sengupta PP, Donal E. LV mechanics in mitral and aortic valve diseases :value of functional assessment beyond ejection fraction. JACC Cardiovasc Imaging. 2014;7(11):1151-1166. doi:10.1016/j.jcmg.2014.07.015.
30. Kearney LG, Lu K, Ord M, et al. Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging 2012:827-833. doi:10.1093/ehjci/jes115.
31. Delgado V, Ng CTA. Assessment of left ventricular systolic function in aortic stenosis and prognostic implications. Eur Heart J Cardiovasc Imaging. 2012;13(10):805-807. doi:10.1093/ehjci/jes136.
1. Wang B, Chen H, Shu X, et al. Emerging role of echocardiographic strain/strain rate imaging and twist in systolic function evaluation and operative procedure in patients with aortic stenosis. Interact Cardiovasc Thorac Surg. 2013;17(2):384-391. doi:10.1093/icvts/ivt171.
2. Chambers JB. Aortic stenosis. Eur J Echocardiogr. 2009;10(1):11-19. doi:10.1093/ejechocard/jen240.
3. Kearney LG, Lu K, Ord M, et al. Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2012;13(10):827-833. doi:10.1093/ehjci/jes115.
4. Nishimura RA, Otto CM. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.; 2017. doi:10.1161/CIR.0000000000000503.
5. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-2786. doi:10.1093/eurheartj/ehx391.
6. Cengiz B, Yurdakul S, Åžahin ÅžT, Kahraman S, Aytekin S. Subclinical Left Ventricular Systolic Dysfunction in Patients with Severe Aortic Stenosis: A Speckle Tracking and Real Time Three Dimensional Echocardiographic Study. J Am Coll Cardiol. 2013;62(18):C2-C3. doi:10.1016/j.jacc.2013.08.014.
7. Ng ACT, Delgado V, Bertini M, et al. Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: A two-dimensional speckle tracking analysis. Eur Heart J. 2011;32(12):1542-1550. doi:10.1093/eurheartj/ehr084.
8. Donal E, Thebault C, Oconnor K, et al. Impact of aortic stenosis on longitudinal myocardial deformation during exercise. Eur J Echocardiogr. 2011;12(3):235-241. doi:10.1093/ejechocard/jeq187.
9. Staron A, Bansal M, Kalakoti P, et al. Speckle tracking echocardiography derived 2-dimensional myocardial strain predicts left ventricular function and mass regression in aortic stenosis patients undergoing aortic valve replacement. Int J Cardiovasc Imaging. 2013;29(4):797-808. doi:10.1007/s10554-012-0160-z.
10. Marcus K a., De Korte CL, Feuth T, et al. Persistent reduction in left ventricular strain using two-dimensional speckle-tracking echocardiography after balloon valvuloplasty in children with congenital valvular aortic stenosis. J Am Soc Echocardiogr. 2012;25(5):473-485. doi:10.1016/j.echo.2012.01.009.
11. Yingchoncharoen T, Gibby C, Rodriguez LL, Grimm RA, Marwick TH. Association of myocardial deformation with outcome in asymptomatic aortic stenosis with normal ejection fraction. Circ Cardiovasc Imaging. 2012;5(6):719-725. doi:10.1161/CIRCIMAGING.112.977348.
12. Voigt JU, Pedrizzetti G, Lysyansky P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16(1):1-11. doi:10.1093/ehjci/jeu184.
13. Yingchoncharoen T, Agarwal S, Popovi ZB. Normal Ranges of Left Ventricular Strain : 2011:185-191. doi:10.1016/j.echo.2012.10.008.
14. Sugimoto T, Dulgheru R, Bernard A, et al. Echocardiographic reference ranges for normal left ventricular 2D strain: Results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2017;18(8):833-840. doi:10.1093/ehjci/jex140.
15. Kusunose K, Goodman A, Parikh R, et al. Incremental prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis and preserved ejection fraction. Circ Cardiovasc Imaging. 2014;7(6):938-945. doi:10.1161/CIRCIMAGING.114.002041.
16. Lafitte S, Perlant M, Reant P, et al. Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr. 2009;10(3):414-419. doi:10.1093/ejechocard/jen299.
17. Delgado V, Tops LF, Van Bommel RJ, et al. Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement. Eur Heart J. 2009;30(24):3037-3047. doi:10.1093/eurheartj/ehp351.
18. Poulsen SH, Søgaard P, Nielsen-Kudsk JE, Egeblad H. Recovery of Left Ventricular Systolic Longitudinal Strain After Valve Replacement in Aortic Stenosis and Relation to Natriuretic Peptides. J Am Soc Echocardiogr. 2007;20(7):877-884. doi:10.1016/j.echo.2006.11.020.
19. Călin A, Roşca M, Beladan CC, et al. The left ventricle in aortic stenosis – imaging assessment and clinical implications. Cardiovasc Ultrasound. 2015;13(1):22. doi:10.1186/s12947-015-0017-4.
20. Lancellotti P, Donal E, Magne J, et al. Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay. Heart. 2010;96(17):1364-1371. doi:10.1136/hrt.2009.190942.
21. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-271. doi:10.1093/ehjci/jev014.
22. Eacvi T, Comparison ASEI, Thomas JD, Farsalinos KE, Daraban AM, Unl S. Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors. J Am Soc Echocardiogr 2015. doi:10.1016/j.echo.2015.06.011.
23. Mirea O, Pagourelias ED, Unl S, Thomas JD, Badano LP, Voigt J. Comparison of Feasibility , Accuracy , and Reproducibility of Layer-Specific Global Longitudinal Strain Measurements Among Five Different Vendors: A Report from the EACVI-ASE Strain Standardization Task Force. J Am Soc Echocardiogr 2018;31:374-381. doi:10.1016/j.echo.2017.11.008.
24. Takigiku K, Takeuchi M, Izumi C, et al. Inter-Vendor Variability for Measurements of Left Ventricular Strain Using Two-Dimensional Speckle Tracking Analysis : A Substudy of Japanese Ultrasound Speckle Tracking of the Left Ventricle ( JUSTICE ) Results Inter-vender agreement : Linear correlation. http://spo.escardio.org/eslides/view.aspx?eevtid=54&fp=P4863 Accеssed October 2018
25. Everett RJ, Clavel M, Pibarot P, Dweck MR, Everett RJ. Timing of intervention in aortic stenosis : a review of current and future strategies. 2018:1-11. doi:10.1136/heartjnl-2017-312304.
26. Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis : A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Hear J Cardiovasc Imaging 2017;18:254-75.
27. Potter E, Marwick TH. Assessment of Left Ventricular Function by Echocardiography. JACC Cardiovasc Imaging 2018;11(2 Pt1):260-74. doi:10.1016/j.jcmg.2017.11.017.
28. Carasso S, Mutlak D, Lessick J, Reisner SA, Rakowski H, Agmon Y. Symptoms in severe aortic stenosis are associated with decreased compensatory circumferential myocardial mechanics. J Am Soc Echocardiogr. 2015;28(2):218-225. doi:10.1016/j.echo.2014.09.006.
29. Galli E, Lancellotti P, Sengupta PP, Donal E. LV mechanics in mitral and aortic valve diseases :value of functional assessment beyond ejection fraction. JACC Cardiovasc Imaging. 2014;7(11):1151-1166. doi:10.1016/j.jcmg.2014.07.015.
30. Kearney LG, Lu K, Ord M, et al. Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging 2012:827-833. doi:10.1093/ehjci/jes115.
31. Delgado V, Ng CTA. Assessment of left ventricular systolic function in aortic stenosis and prognostic implications. Eur Heart J Cardiovasc Imaging. 2012;13(10):805-807. doi:10.1093/ehjci/jes136.
Published
2018-12-27
How to Cite
ZAFIROVSKA, Planinka et al.
EVALUATION OF THE LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN IN PATIENTS WITH SEVERE AORTIC STENOSIS THAT UNDERGO SURGICAL AORTIC VALVE REPALCEMENT: A CASE REPORT.
Journal of Morphological Sciences, [S.l.], v. 1, n. 2, p. 9-14, dec. 2018.
ISSN 2545-4706.
Available at: <https://jms.mk/jms/article/view/31>. Date accessed: 22 dec. 2024.
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