Pathophysiological background and prognostic implication of systolic aortic root motion in non-ischemic dilated cardiomyopathy

Matthias Aurich,Benjamin Meder,Derliz Mereles,Matthias Niemers,Matthias Müller-Hennessen,Lorenz Uhlmann,Hugo A Katus,Patrick Fuchs,Sebastian Greiner,Evangelos Giannitsis,Philipp Ehlermann

doi:10.1038/s41598-019-40386-z

Matthias Aurich, Benjamin Meder + Show 9 more

Open Access

https://doi.org/10.1038/s41598-019-40386-z

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Journal: Scientific Reports	Publication Date: Mar 7, 2019
Citations: 7	License type: open-access

Affiliation: Heidelberg University, Zimmer Biomet (Germany)

Abstract

Recordings of aortic root movement represent one of the first accomplishments of ultrasound in medicine and mark the beginning of functional cardiac imaging. However, the underlying mechanism is not completely understood. Since the aortic root is directly connected to the cardiac skeleton we hypothesize, that the amplitude of systolic aortic root motion (SARM) may be mainly caused by displacement of the cardiac base towards the apex and might therefore be used as measure of left ventricular longitudinal function (LV-LF). One hundred and eighty patients with dilated cardiomyopathy and 180 healthy controls were prospectively included into this study. SARM was lower in patients compared to controls (9 ± 3 mm vs. 12 ± 2 mm, p < 0.001) and lowest in patients with cardiovascular events (9 ± 3 mm vs. 7 ± 3 mm, p < 0.001). During a median follow-up time of 38 months, the combined end-point of cardiovascular death or hospitalization for heart failure was reached by 25 patients (13.9%). Reduced SARM had significant prognostic impact on outcome (hazard ratio 0.74, 95% confidence interval 0.63–0.88, p < 0.001) and remained an independent predictor in the multivariate analysis. Compared to parameters with potential influence on its mechanism, SARM correlated best (r = 0.75, p < 0.001) with global longitudinal strain (GLS). SARM may therefore represent an alternative echocardiographic parameter for the assessment of LV-LF, particularly when GLS is not feasible or apical views are not available.

Highlights

Left ventricular (LV) contraction is determined by a complex arrangement of muscle fiber layers and comprises longitudinal shortening and axial twist
Best correlations were found for systolic aortic root motion (SARM) and global longitudinal strain (GLS) (r = 0.75 and 0.78, respectively, Fig. 3A,B) as well as SARM and ejection fraction (EF) (r = 0.74, Supplementary Fig. S1A)
Weaker associations were found to stroke volume (SV) and left atrial volume change (LA-VC) (r = 0.57 and 0.61, respectively, Supplementary Fig. S1B,C) and no correlation to mean arterial pressure (MAP) (r = 0.21, Supplementary Fig. S1D)

Summary

Introduction

Left ventricular (LV) contraction is determined by a complex arrangement of muscle fiber layers and comprises longitudinal shortening and axial twist. 2- and 3-dimensional systems have improved its diagnostic potential continuously[6,7] but they still face limitations especially when dealing with poor acoustic windows In such cases M-mode echocardiography is a helpful alternative. By contrast enhanced echocardiography using saline injection in the supravalvular position Gramiak et al confirmed that undulating parallel signals medial to the mitral valve arise distal from the aortic valve and represent a portion of the aorta. They could demonstrate, that the pattern of motion obtained from the aortic root equals www.nature.com/scientificreports/. We hypothesize, that the amplitude of systolic aortic root motion (SARM) obtained by M-Mode echocardiography may be used as a measure of global LV-LF (Figs 1 and 2)

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Discussion

Conclusion