Recovery of Left Ventricular Systolic Longitudinal Strain After Valve Replacement in Aortic Stenosis and Relation to Natriuretic Peptides

Abstract

We sought to examine left ventricular (LV) longitudinal systolic myocardial contractility in isolated valvular aortic stenosis (AS) before and after valve replacement and relation to natriuretic peptides. In all, 45 patients with symptomatic AS without significant coronary artery disease were studied by serial tissue Doppler echocardiography and analysis of plasma atrial and brain natriuretic peptide (Nt-pro-BNP). LV myocardial systolic strain was significantly reduced in AS with preserved ejection fraction and most pronounced in patients with advanced heart failure symptoms. Nt-pro-BNP was significantly related to LV mass index and mean LV strain (r = 0.63, P < .001; and r = 0.61, P < .001, respectively). Mean myocardial systolic strain increased after valve replacement (baseline -9 +/- 4% vs -14 +/- 4% at 12 months, P < .001). The increase of systolic strain and the observed regression of LV mass index were independently related to changes of Nt-pro-BNP (r = -0.67, P < .001; and r = -0.71, P < .001, respectively) during 12 months of follow-up after valve replacement. A significant association was found between changes of plasma atrial natriuretic peptide and echocardiographic markers of LV diastolic function. LV longitudinal systolic strain is severely depressed despite preserved LV ejection fraction and fractional shortening in AS. A significant association exists among natriuretic peptides, myocardial longitudinal contractility, and the degree of symptoms. Reverse LV remodeling after aortic valve replacement with regression of myocardial hypertrophy results in improvement of LV longitudinal myocardial strain and decrease of Nt-pro-BNP plasma levels. LV strain analysis might have the potential to identify patients with asymptomatic AS who might benefit from earlier surgical intervention to preserve overall LV function.