Left ventricular contraction pattern in asymptomatic patients with moderate to severe aortic regurgitation

Abstract

Background: The aim of the study was to compare systolic left ventricular (LV) contraction pattern in patients with moderate to severe aortic regurgitation (AR) with healthy controls (C) by real-time three-dimensional echocardiography (RT3DE). Methods: Twenty patients and 15 age matched controls were compared (35±4 (SD) and 38±9 years, respectively, p=NS). All were examined with transthoracic three-dimensional speckle tracking. LV end-diastolic volume LVEDV, end-systolic volume (LVESV), LV ejection fraction (LVEF), LV mass index (LVMi) and global tissue deformation parameters (strain and strain rate) were measured in the three orthogonal axes (long axis, circumferential axis and radial axis). Results: Heart rate was similar in the AR and the C group (62±11 and 59±8 bpm, respectively, p=NS). Brachial pulse pressure was higher in AR patients (71±17 vs 50±5 mmHg, p< 0,02). In the two groups (AR vs C) LVEDV was (233±37 and 145±23 ml (p<0,02), LVESV 87±15 and 58±10 ml (NS), LVEF (63±3 and 61±2%) (p=NS) and LVMi (119±23 and 87±11 g/m2 (p<0,02). Peak global systolic longitudinal strain and strain rates were reduced in the AR group (-0,16±0,02 vs 0,18±0,02, p<0,02) and (-0,73±0,10 vs -0,83±0,08 1/s, p<0,02), while peak systolic circumferential and radial strains (-0,18±0,03 vs -0,17±0,02, p=NS and 0,47±0,07 vs 0,49±0,05, p=NS) and strain rates (-0,84±0,10 vs -0,84±0,10 1/s) did not differ between groups (p=NS). Systolic longitudinal strain and strain rates correlated well with EDV (p=0,004 and p=0,021, respectively), while no correlation was demonstrated for circumferential or radial strain/strain rate (p=NS). Conclusion: RT3DE identifies non-homogenous remodeling in patients with chronic moderate to severe aortic regurgitation. Isolated reduction of longitudinal strain and strain rate was demonstrated, and was strongly correlated to the volume loaded left ventricle.