ALTERATIONS IN LEFT ATRIAL AND LEFT VENTRICULAR MYOCARDIAL FUNCTION IN MIXED AORTIC VALVE DISEASE

Abstract

Patients with mixed aortic valve disease (MAVD; combined moderate or > aortic stenosis (AS) and moderate or > aortic regurgitation) have poorer outcomes compared to those with isolated severe AS. Little is known of the impact of MAVD on left atrial (LA) and left ventricular (LV) myocardial mechanics. We aim to characterize LA and LV myocardial function in MAVD patients. We retrospectively identified 184 patients, 35 moderate MAVD (moderate AS and moderate aortic regurgitation), 40 severe MAVD (severe AS and moderate aortic regurgitation), 33 isolated severe AS, 31 isolated severe aortic regurgitation, and 45 controls, who underwent transthoracic echocardiogram. Simultaneous speckle-tracking longitudinal strain (LS) analysis of the LA and LV were performed on the apical 4-chamber view (EchoInsight, Epsilon) to obtain LV peak LS and LA peak, contractile, and conduit strain. ANOVA with post-hoc Tukey’s test was used to compare groups. P < 0.05 was considered significant. Results are presented in Table 1. Compared to controls, LV peak LS was significantly reduced in moderate MAVD, severe MAVD and severe AS patients. LV peak LS was not significantly different between moderate MAVD and severe AS patients but was significantly lower in the severe MAVD group. Severe aortic regurgitation patients had higher peak LS compared to controls, moderate MAVD, severe MAVD and severe AS patients. LA peak, conduit and contractile strains were significantly reduced in moderate MAVD, severe MAVD and severe AS patients compared to controls and severe aortic regurgitation patients. LA peak and contractile strains were not different between the moderate MAVD, severe MAVD or severe AS groups. However, LA conduit strain was significantly reduced in those with severe MAVD compared to the moderate MAVD but not the severe AS group. The severe aortic regurgitation group had preserved LA peak, conduit and contractile strain compared to the other groups. Moderate MAVD patients have a reduction in LV and LA myocardial function comparable to isolated severe AS patients. Severe MAVD patients have a greater decline in LV peak LS and LA conduit strain compared to moderate MAVD or severe AS patients. These changes may contribute to the poorer outcomes observed in MAVD patients.