Assessment of Cyclic Changes in the Diameter of the Aortic Annulus Using Speckle-Tracking Trans-esophageal Echocardiography

Abstract

It is uncertain whether dynamic variation in the diameter of the aortic annulus occurs during the cardiac cycle in humans. The purpose of this study was to analyze cyclic changes of the aortic annulus using speckle-tracking trans-esophageal echocardiography. The subjects were 40 patients with aortic stenosis and 40controls. Absolute and relative changes in the diameter of the aortic annulus and the times at which the maximum and minimum diameters occurred during the cardiac cycle were determined using speckle-tracking trans-esophageal echocardiography. The maximum and minimum diameters were 22.9±2.7 and 20.0±2.9mm, respectively, in controls. The change in diameter of the aortic annulus was 2.9±0.7mm, and the relative change was 12.9±3.5%. The maximum aortic annulus diameter was reached at the onset of aortic valve opening, and the minimum diameter occurred in the rapid filling phase. The change in diameter of the aortic annulus was significantly smaller (2.2±0.6mm vs. 2.9±0.7mm, p<0.0001), and the time to reach the maximum diameter was significantly longer (98.5±17.5ms vs. 83.4±18.2ms, p=0.0004), in the aortic stenosis group than in the control group. The study found that dynamic changes of the aortic annulus occur in the cardiac cycle and can be measured using speckle-tracking trans-esophageal echocardiography. We also found that aortic stenosis has an effect on the extent and timing of these changes. This suggests that accurate assessment of aortic annulus diameter requires consideration of the timing of the cardiac cycle.