Aortic Regurgitation Patients Research Articles

Usefulness of peripheral arterial signs in the evaluation of aortic regurgitation

BackgroundEarly diagnosis and optimal timing of surgical repair for chronic aortic regurgitation (AR) are topics of interest, because left ventricular compensation delays the clinical signs of the early stages of left ventricular dysfunction. Various physical signs have been described as indicators of chronic AR, but AR screening can be difficult depending on the proficiency of primary care providers. The recent use of the cardio-ankle vascular index (CAVI) measurement to assess peripheral atherosclerosis may detect AR objectively and simply because its arterial pulse wave configuration is closely related to the physical signs of AR. MethodsCAVI measurements include pulse pressure (PP), the difference in blood pressures between upper and lower limbs (ABD), ankle-brachial index (ABI), ejection time (ET), and upstroke time (UT). We evaluated the differences in CAVI parameters between AR group and age-matched control group, the relationships between CAVI parameters and the echocardiographic semi-quantitative measurements of AR severity such as left ventricular dimensions (Dd, Ds) and vena contracta (VC), and between the changes in CAVI parameters before and after aortic valve replacement. ResultsABD, PP, ET, ankle systolic pressure and ABI in the AR group were significantly higher than that in the control group. Brachial diastolic pressure and CAVI in the AR group were significantly lower than that in the control group. UT was lower than that in the control group (p=0.05). PP did not correlate with the semi-quantitative AR severity, but ABD was correlated with Dd, Ds, and VC and was negatively correlated with UT. The exaggerated ABD, PP, ET, and ABI were moderated after surgery. ConclusionsCAVI parameters could be useful in the screening and serial follow-up of AR patients.

Holodiastolic Flow Reversal at the Descending Aorta on Cardiac Magnetic Resonance is Neither Sensitive Nor Specific for Significant Aortic Regurgitation in Patients with Congenital Heart Disease.

Holodiastolic flow reversal in the descending aorta on echocardiogram suggests significant aortic regurgitation. The study aim was to determine whether the presence of holodiastolic flow reversal on cardiac magnetic resonance imaging (MRI) correlates with aortic valve regurgitant fraction. We retrospectively reviewed 166 cardiac MRIs (64% male, age 14.1±9.5years) from January 2011 to May 2012 where velocity mapping was acquired at both the aortic valve and the descending aorta at the level of the diaphragm. Descending aorta velocity maps were checked for baseline offset using a static reference region. Holodiastolic flow reversal was defined as flow reversal throughout diastole both before and after baseline correction. Significant aortic regurgitation was defined as regurgitant fraction >10%. Aortic valve regurgitant fraction was <10% in 144 patients (Group A), 10-20% inclusive in 7 patients (Group B), and >20% in 15 patients (Group C). Though the aortic valve regurgitant fraction was significantly higher for patients with holodiastolic flow reversal versus those without (8.5±14.2 vs. 3.8±6.6%, p=0.02), holodiastolic flow reversal was present in 32 Group A patients (22%). In comparison, 4 Group B patients (57%) and 7 Group C patients (47%) had holodiastolic flow reversal. The sensitivity (Groups B and C) was 0.5, and the specificity (Group A) was 0.78. Holodiastolic flow reversal in the descending aorta on cardiac MRI was neither sensitive nor specific for predicting significant aortic regurgitation in this study population. Holodiastolic flow reversal in the absence of significant aortic regurgitation may be a relatively common finding in patients with congenital heart disease.

Dilatation of the ascending aorta is associated with presence of aortic regurgitation in patients after repair of tetralogy of Fallot

To evaluate the association between aortic morphology and elasticity with aortic regurgitation in surgically corrected of tetralogy of Fallot (TOF) patients. We retrospectively identified 72 consecutive patients with surgically corrected TOF and 27 healthy controls who underwent cardiac MRI evaluation. Velocity-encoded cine MRI was used to quantify degree of aortic regurgitation (AR) in TOF patients. Ascending aorta diameters were measured at standard levels on MRA images. Aortic pulse-wave velocity (PWV) was quantified with MRI. Morphological and functional MRI variables were compared between groups of TOF patients with and without clinically relevant AR and controls. The association between aortic morphology and elasticity with the presence of AR was evaluated using univariate and multivariate logistic regression. The majority of TOF patients had only trace AR. Nine TOF patients (12 %) had an AR fraction higher than 15 %. Indexed aorta diameter at the sinotubular junction (p = 0.007), at the RPA level (p = 0.006), and low left ventricular ejection fraction (LVEF) (p = 0.015) showed the strongest associations with the presence of at least mild AR, which persisted after controlling for age and gender. Increased ascending aorta dimension is associated with AR in patients after repair of TOF. LVEF was also low in the group of patients with relevant AR compared to those without, suggesting even mild to moderate AR may contribute to LV dysfunction in these patients. Enlarged ascending aorta may be an indication for precise quantification of regurgitant fraction with MRI, since symptomatic patients may need aortic valve repair when moderate regurgitation is present.

0036 : Prognostic value of concomitant aortic regurgitation in patients operated for severe aortic stenosis

The aim of this study was to evaluate the prognostic value of concomitant aortic regurgitation (AR) in patients operated for severe aortic stenosis (AS) by examining the impact of presence and severity of concomitant AR in patients operated for severe AS on short-term outcome. Retrospective study including 37 consecutive patients operated due to severe AS. Patients were divided in two groups, G1: AS group (n=15) and G2: AS + AR (n=22). All patients had a transthoracic echography a week and 6 months after cardiac surgery. Patients mean age was 59,08 with older patients in group 66,16±6,4 vs 54,27±16,3 (p=0,012). 59,5% of the patients were males. Dyspnoea was the predominating symptom (74%) with 40% in stage II and 26% in stage III of NYHA. Coronary artery disease was more frequent in G1 (33% vs 14%; p=0,079, NS). Pre-operative echocardiography showed no difference between the two groups for left ventricular ejection, LV hypertrophy, mean aortic gradients, aortic area and pulmonary pressure. However mean LV diameters were greater in G2 with a mean LV end diastolic diameter (LVEDD) à 58,95±8,4 mm vs 51,2±8,19 mm (p=0,018) and LV end systolic diameter (LVESD) à 39,6±10,5 mm vs 33,2±8,79 mm (p=0,049). Immediate and short-term echocardiographic follow-up showed no difference between the 2 groups. Only LV diameters were greater in G2 avec un LVEDD 59,1 mm vs 51 mm (p=0,03) et LVESD 40,3 mm vs 33,2 mm (p=0,02) à 1 week and LVEDD at 58, 8±9,9 mm vs 50,7±8,19 mm (p=0,032) and LVESD à 40,1±9,7 mm vs 32,8±12 mm (p=0,024) at 6 months. Our data indicate that the preoperative presence of concomitant AR was associated with greater LV diameters. The author hereby declares no conflict of interest

Left Ventricular Hypertrophy in Asymptomatic Nonsevere Aortic Stenosis

Increased biomechanical stress on cardiomyocytes because of outflow obstruction secondary to aortic stenosis (AS) is thought to induce reexpression of the fetal gene program, which modifies myocyte efficiency, sarcomere composition, and regulation of extracellular matrix, as well as various nuclear signal transduction pathways resulting in autocrine production and secretion of cytokines, neurohormones and growth factors that ultimately promote ventricular hypertrophy.1,2 See Article by Gerdts et al The traditional view of adaptative concentric left ventricular hypertrophy (LVH) because of parallel replication of new sarcomeres is that wall thickness increases to normalize LV systolic wall stress and preserve systolic performance. This view, accepted for the past 40 years3 and perhaps counterintuitively expected to mitigate the effects of LV pressure overload on cardiovascular morbidity and mortality, has begun to be challenged by new clinical data, suggesting that moderate or severe LVH may be associated with adverse outcomes in AS4,5 and that inappropriately increased LV mass, found in 17% of patients with mild to moderate AS6 and in 67% of patients with asymptomatic severe AS, was associated with a 4.5-fold increased risk of cardiovascular events.7 Conversely, the absence of hypertrophy in one third of the patients with severe AS seems to have no adverse effects on systolic function or survival.8,9 Experimental studies in genetically modified animal models are consistent with clinical observations.10 In addition, no association was found between AS severity and the magnitude or pattern of LVH using cardiac magnetic resonance.11 Thus, it seems that the presence, severity, and the geometric pattern of LVH in AS vary widely, are …

Transapical transcatheter aortic valve implantation using a new second-generation TAVI system — J-Valve™ for high-risk patients with aortic valve diseases: Initial results with 90-day follow-up

BackgroundTo evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis (AS) or pure/dominant aortic regurgitation (AR) using the J-Valve™ system. MethodsTwenty patients with isolated aortic valve disease (11 with pure/dominant AR and 9 with AS) at high risk for open-heart surgery were enrolled in this study. The mean Logistic Euro-SCORE I was 27.2±8.2% (mean age 74.5±4.7years). Four sizes of prosthesis were used for annular size up to 21 mm (n=1), 23mm (n=2), 25mm (n=10) and 27mm (n=7). Clinical and echocardiographic evaluations were performed at baseline, post-procedure and follow-up. The primary endpoint was all-cause mortality. Secondary endpoints were procedural success, major adverse events as well as echocardiographic performance. ResultsTAVI with the J-Valve™ device was successfully performed in 19 patients (95%). Conversion to surgical valve replacement was necessary in one patient due to prosthesis embolization. No mortality occurred during 90 days follow-up. Pacemaker implantation for new onset conduction disorders was necessary in one patient (5%). For patient with severe AS, post-procedure TAVI resulted in favorable reduction of mean transvalvular gradients (55.3±8.5 vs. 16.4±13.3 mmHg, P<0.01). Mean transvalvular gradient was also favorable in AR patients after valve implantation (6.9±1mmHg). The majority of patients had none or trivial paravalvular regurgitation (17/19) while none had moderate or severe paravalvular regurgitation. ConclusionTrans-apical TAVI using the J-Valve™ prosthesis is potentially an effective treatment option for patients with AS or pure/dominant AR at high risk for open-heart surgery.

Comparison of Left Ventricular Myocardial Structure and Function in Patients with Aortic Stenosis and Those with Pure Aortic Regurgitation

Objective: We aimed to support the structural and functional distinction between aortic stenosis (AS) and aortic regurgitation (AR). Methods: Biopsy specimens taken from 70 selected patients (35 with AS and 35 with AR) undergoing aortic valve replacement (AVR) were analyzed for their cardiomyocyte dimensions and structure, interstitial fibrosis and contractile function. To determine normal values of contractile function, 10 donor hearts were analyzed. Results: Cardiomyocyte diameter was higher in AS than in AR (22.7 ± 2.2 vs. 13.2 ± 0.7 µm, p < 0.001). Length was higher in AR (121.2 ± 9.4 vs. 95.6 ± 3.7 µm, p < 0.001). Collagen volume fraction was increased in both AS and AR, but was lower in the AS specimens (7.7 ± 2.3 vs. 8.9 ± 2.3, p = 0.01). Myofibril density was reduced in AR (38 ± 4 vs. 48 ± 5%, p < 0.001). Cardiomyocyte diameter and length were closely linked to the relative left ventricular (LV) wall thickness (R² = 0.85, p < 0.001 and R² = 0.68, p = 0.003). The cardiomyocytes of AS patients had higher F_passive (6.6 ± 0.3 vs. 4.6 ± 0.2 kN/m², p < 0.001), but their total force was comparable. F_passive was also significantly higher in AS patients with restrictive rather than pseudo-normal LV filling (7.3 ± 0.5 vs. 6.7 ± 0.6, p = 0.004). In AS patients, but not in AR patients, F_passive showed a significant association with the cardiomyocyte diameter (R² = 0.88, p < 0.001 vs. R² = 0.31, p = 0.6). Conclusions: LV myocardial structure and function differ in AS and AR, allowing for compensative adjustment of the diastolic/systolic properties of the myocardium.

Impact of Mixed Aortic Valve Stenosis on VARC-2 Outcomes and Postprocedural Aortic Regurgitation in Patients Undergoing Transcatheter Aortic Valve Implantation: Results From the International Multicentric Study PRAGMATIC (Pooled Rotterdam-Milan-Toulouse in Collaboration).

We sought to evaluate the impact of mixed aortic stenosis (MAS) on postprocedural aortic regurgitation (PPAR) and clinical outcomes after transcatheter aortic valve implantation (TAVI). The impact of MAS of TAVI outcomes is unknown. Data from a multicenter registry were retrospectively analysed. Outcomes were compared between patients with pure aortic stenosis (PAS; associated AR<1+/3+) and MAS (associated AR≥1+/3+). Study objectives were PPAR incidence and short- and long-term mortality. Overall, 1,062 patients were included: 419 (39.4%) with MAS and 643 (60.5%) with PAS. At 30 days, there were no differences in mortality, however, a higher incidence of major bleeding (22.7% vs. 16.8%; P=0.016), PPAR≥1+/3+ (42.6% vs. 26.5%; P<0.001) and lower device success (89.3% vs. 93.3%; P=0.019) was observed in patients with MAS. Of note, MAS was an independent predictor of PPAR≥1+/3+ at multivariable analysis (OR: 2.882; CI: 1.851-4.488; P<0.001). At 2 years of follow-up, no survival differences were present between MAS and PAS groups. Similarly, following stratification for PPAR≥1+/3+, MAS had no protective effect on survival as compared with PAS. MAS was associated with lower device success and higher PPAR incidence. However, despite these findings, it had no influence on long-term postoperative outcomes.

Left ventricular shape and mass impact torsional dynamics in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction.

Chronic aortic regurgitation (AR) is associated with a unique pattern of left ventricular (LV) volume and pressure overload, leading to LV remodelling. LV torsional motion, a key component of LV performance, can be altered in this setting. We aimed to assess the impact of LV remodelling on LV torsional dynamics parameters using speckle-tracking echocardiography (STE) in asymptomatic AR patients. We prospectively enrolled 60 patients with chronic AR and LVEF > 50% and 55 healthy controls. LV rotation, twisting and untwisting were assessed using STE. Patients with AR had higher LV diameters, volumes and mass, a more spherical LV shape than controls, but similar LVEF. In AR patients we found reduced peak LV apical rotation and decreased (2.1 ± 0.8 vs 2.9 ± 0.9°/cm, p < 0.001) and delayed (time to peak LV twist: 0.94 ± 0.12 vs 0.99 ± 0.09, p = 0.004) peak LV torsion. Also, peak LV untwisting velocity was decreased (-123.5 ± 41.5 vs -152.3 ± 55.0°/s, p = 0.002) due to lower peak LV apical diastolic rotation rate. LV shape influenced LV torsional dynamics, a more spherical LV displaying reduced peak LV apical rotation and diastolic rotation rate and decreased LV twist. A more hypertrophied LV had a lower peak LV torsion, peak LV apical diastolic rotation rate and peak LV untwisting velocity. LV apical rotation and torsion are decreased and LV twist is delayed in patients with chronic AR and normal LVEF, detecting early subclinical LV dysfunction before LVEF declines. Also, LV untwisting is reduced in these patients. LV remodelling impairs LV torsional dynamics parameters in this setting.

Определение детерминант функциональной аортальной регургитации у пациентов с аневризмой восходящей аорты с помощью чреспищеводной эхокардиоскопии

We used transesophageal echocardioscopy for the study of effects of linear parameters of the aortic root and characteristics of its subvalvular space (area of subvalvular space of the aortic root during diastole and aortic cusps coaptation height) on severity of aortic regurgitation in patients with aneurism of ascending aorta and anatomically unchanged aortic valve (AV), i.e. so-called functional aortic regurgitation (FAR). We found that appearance of FAR was associated with coefficient of disproportion sinotubular ridge/fibrous annulus of AV > 1.67, aortic cusps coaptation height > 0.47 cm and area of subvalvular space of the aortic root >0.49 cm2. Respective values > 2.23, > 1.07 cm, 0.49 cm2 evidenced for the presence of pronounced FAR.

The role of annular dimension and annuloplasty in tricuspid aortic valve repair.

Valve sparing reimplantation can improve the durability of bicuspid aortic valve repair compared with subcommissural annuloplasty, especially in patients with a large basal ring. This study analyses the effect of basal ring size and annuloplasty on valve repair in the setting of a tricuspid aortic valve. From 1995 to 2013, 382 patients underwent elective tricuspid aortic valve repair. We included only those undergoing subcommissural annuloplasty, valve sparing reimplantation or no annuloplasty and in whom intraoperative transoesophageal echocardiography images were available for retrospective pre- and post-repair basal ring measurements (n = 323, subcommissural annuloplasty: 146, valve sparing reimplantation: 154, no annuloplasty: 23). In a subgroup of patients with available echocardiographic images, basal ring was retrospectively measured at the latest follow-up or prior to reoperation. subcommissural annuloplasty and valve sparing reimplantation were compared after matching for degree of aortic regurgitation and root size. All three groups differed significantly for most of preoperative characteristics. Hospital mortality was 0.9%. The median follow-up was 4.7 years. At 8 years, overall survival was 80 ± 5%. Freedom from reoperation and freedom from aortic regurgitation >1+ were 92 ± 5% and 71 ± 8%, respectively. In multivariate analysis, predictors of aortic regurgitation >1+ were left ventricular end-diastolic diameter (P = 0.003), cusp repair (P = 0.006), body surface area (P = 0.01) and subcommissural annuloplasty (P = 0.05). In subcommissural annuloplasty, freedom from aortic regurgitation >1+ was lower for patients with basal ring ≥28 mm compared with patients with basal ring <28 mm (P = 0.0001). In valve sparing reimplantation, freedom from aortic regurgitation >1+ was independent of basal ring size (P = 0.38). In matched comparison between subcommissural annuloplasty and valve sparing reimplantation, freedom from aortic regurgitation >1+ was not significantly different (P = 0.06), but in patients with basal ring ≥28 mm, valve sparing reimplantation was superior to subcommissural annuloplasty (P = 0.04). Despite similar intraoperative reduction in basal ring size in subcommissural annuloplasty and valve sparing reimplantation, patients with subcommissural annuloplasty exhibited greater increase in basal ring size during the follow-up compared with the valve sparing reimplantation group (P < 0.001). As with a bicuspid aortic valve, a large basal ring predicts recurrence of aortic regurgitation in patients with tricuspid aortic valve undergoing repair with the subcommissural annuloplasty technique. This recurrence is caused by basal ring dilatation over time after subcommissural annuloplasty. With the valve sparing reimplantation technique, large basal ring did not predict aortic regurgitation recurrence, as prosthetic-based circumferential annuloplasty displayed better stability over time. Stable circumferential annuloplasty is recommended in tricuspid aortic valve repair whenever the basal ring size is ≥28 mm.

Calcium Load of the Aortic Annulus Quantified by Computed Tomography Predicts the Occurrence of Conduction Disturbances and Residual Aortic Regurgitation in Patients Undergoing Transcatheter Aortic Valve Implantation

Calcium Load of the Aortic Annulus Quantified by Computed Tomography Predicts the Occurrence of Conduction Disturbances and Residual Aortic Regurgitation in Patients Undergoing Transcatheter Aortic Valve Implantation

Reduced Longitudinal Function in Chronic Aortic Regurgitation.

BackgroundChronic aortic regurgitation (AR) patients demonstrate left ventricular (LV) remodeling with increased LV mass and volume but may have a preserved LV ejection fraction (EF). We hypothesize that in chronic AR, global longitudinal systolic and diastolic function will be reduced despite a preserved LV EF.MethodsWe studied with Doppler echocardiography 27 normal subjects, 87 patients with chronic AR with a LV EF > 50% (AR + PEF), 66 patients with an EF < 50% [AR + reduced LV ejection fraction (REF)] and 82 patients with hypertensive heart disease. LV volume, transmitral spectral and tissue Doppler were obtained. Myocardial velocities and their timing and longitudinal strain of the proximal and mid wall of each of the 3 apical views were obtained.ResultsAs compared to normals, global longitudinal strain was reduced in AR + PEF (13.8 ± 4.0%) and AR + REF (11.4 ± 4.7%) vs. normals (18.4 ± 3.6%, both p < 0.001). As an additional comparison group for AR + PEF, global longitudinal strain was reduced as compared to patients with hypertensive heart disease (p = 0.032). The average peak diastolic annular velocity (e') was decreased in AR + PEF (6.9 ± 3.3 cm/s vs. 13.4 ± 2.6 cm/s, p < 0.001) and AR + REF (4.8 ± 2.1 cm/s, p < 0.001). Peak rapid filling velocity/e' (E/e') was increased in both AR + PEF (14.4 ± 6.2 vs. 6.2 ± 1.3, p < 0.001) and AR + REF (18.8 ± 6.4, p < 0.001 vs. normals). Independent correlates of global longitudinal strain (r = 0.6416, p < 0.001) included EF (p < 0.0001), E/e' (p < 0.0001), and tricuspid regurgitation velocity (p = 0.0176).ConclusionWith chronic AR, there is impaired longitudinal function despite preserved EF. Moreover, global longitudinal strain was well correlated with noninvasive estimated LV filling pressures and pulmonary systolic arterial pressures.

Abstract 17131: Diastolic Dysfunction in Asymptomatic Patients With Moderate to Severe Aortic Regurgitation is Strongly Related to Increased Longitudinal Fiber Stress and Subsequent Non-uniform Myocardial Relaxation

Introduction: Diastolic dysfunction in aortic regurgitation (AR) is present at an early stage of the disease. Yet, the mechanisms are not clearly understood. Hypothesis: We hypothesized that diastolic dysfunction in AR patients is caused by increased longitudinal (meridional) fiber stress and subsequent impaired relaxation of the corresponding subendocardial (longitudinal) fibers. Methods: Thirty asymptomatic patients with moderate to severe aortic regurgitation (AR) and 17 age matched healthy controls (C) where analyzed (32 ± 7 and 35 ± 4 (SD) years, respectively, p=NS) with 3D speckle tracking echocardiography. We measured early diastolic longitudinal- (LSRe) and circumferential (CSRe) strain rate (1/s) as the time derivative of strain (%) and the peak difference (LSRe – CSRe) during isovolumic relaxation (IVR). Early diastolic flow rate (sec -1 ) was estimated as the time derivative of the LV volume curve normalized to end-diastolic volume (EDV). Finally, we calculated end-systolic meridional fiber stress (mmHg). Results: LV ejection fraction in C and AR was 61 ± 2 and 62 ± 3 %, respectively (p=NS). AR patients had signs of impaired LV filling with lower early diastolic flow rate (Table 1). During IVR, the strain rate curves consistently departed (Figure 1, arrow), indicating a non-homogenous relaxation. A negative correlation was shown between meridional fiber stress and the IVR strain rate gradient (y= -0.0123x + 1.0921, r=0.61, p&lt;0.001). Conclusions: We have demonstrated a non-homogenous relaxation of subendocardial- relative to circumferential fibers in AR patients that strongly correlated with longitudinal fiber stress, suggesting a causal relationship.

Abstract 12760: Left Ventricular (LV) Remodeling in Aortic Regurgitation Differs From Athlete’s Heart With Similar LV Volumes and is Closely Related to Different Fiber Stress Distribution

Introduction: Elite endurance athletes often develop left ventricular dilatation comparable to that observed in aortic regurgitation (AR). Hypothesis: We hypothesized that the LV remodeling observed in athlete’s heart differs from that seen in AR, and that the difference may be attributed to different fiber stress distribution. Methods: Thirty asymptomatic patients with moderate to severe AR, 15 age matched elite endurance athletes (Athl) and 17 age matched healthy controls (C) where analyzed with 3D speckle tracking echocardiography. We calculated the ratio between peak systolic circumferential (CS) - and peak systolic longitudinal strain (LS) and end-systolic (ES) circumferential (ESSc) and meridional (ESSm) fiber stress. Results: LV ejection fraction in C, Athl and AR patients was (61 ± 2, 61 ± 3 and 62 ± 3%, respectively, p=NS). LV end-diastolic volume was 78 ± 11, 112 ± 13 and 117 ± 20 ml/m 2 in C, Athl and AR, respectively, (C vs AR and Athl, p&lt;0.01, AR vs Athl, p=NS). A non-uniform contraction pattern with a rightward shift of the LS strain curve was observed in AR (Figure 1). The CS/LS ratio was 0.91 ± 0.11, 0.91 ± 0.16 and 1.12 ± 0.24 in C, Athl and AR, respectively, (AR vs C and Athl, p&lt;0.01, C vs Athl, p=NS). Consistently, the ESSc/ESSm ratio was similar in C and Athl (1.75 ± 0.08 and 1.74 ± 0.07, respectively, p=NS) and lower in AR patients (1.67 ± 0.07, AR vs C and Athl, p&lt;0.01), indicating a relative increase in meridional fiber stress in the AR group (Figure 2). Conclusions: We have demonstrated that LV remodeling in AR patients differs from athlete’s heart with similar LV volumes, and may be attributed to a shift in the circumferential-meridional fiber stress ratio in AR patients.

TCT-664 Cardiac Magnetic Resonance Versus Transthoracic Echocardiography for the Assessment and Quantification of Aortic Regurgitation in Patients Undergoing Transcatheter Aortic Valve Implantation

TCT-664 Cardiac Magnetic Resonance Versus Transthoracic Echocardiography for the Assessment and Quantification of Aortic Regurgitation in Patients Undergoing Transcatheter Aortic Valve Implantation

Cardiac magnetic resonance versus transthoracic echocardiography for the assessment and quantification of aortic regurgitation in patients undergoing transcatheter aortic valve implantation

BackgroundThe transthoracic echocardiographic (TTE) evaluation of the severity of residual aortic regurgitation (AR) following transcatheter aortic valve implantation (TAVI) has been controversial and lacks validation.ObjectivesThis study sought to compare TTE...

Quantification analysis of the leaflet anatomy in aortic regurgitation patients using real-time three-dimensional echocardiography

Objective To quantitatively analysis the aortic valve leaf anatomical characteristics in aortic regurgitation(AR) patients by real-time three-dimensional transesophageal echocardiography (RT-3D-TEE),and screening the parameters which significantly affect AR to further reveal the mechanism of AR.Methods 32 patients with AR were enrolled as AR group and 20 cases of non-AR people were involved as control group.RT-3D-TEE was using to collect images in two groups and offline analysis was performed.4 sets of parameters of the aortic valves(left coronary valve,right coronary valve,and non-coronary valve):leaflet edge length(LL,RL,NL),leaflet height (LH,RH,N H),leaflet length/height ratio (LRa,RRa,NRa),leaflet tip plane distance(LTH,RTH,NTH) were acquired.Parameters of two groups were compared,and the parameters were incorporated into the logistic regression model,then the ROC curves were obtained.Results ①Compared with the control group,LL,RL,NL,RH,LRa,NRa,RRa in AR group increased (P ＜ 0.05),while the rest parameters had no statistical differences (P ＞0.05).②Multivariable logistic regression model gradually screening of the significant factors influencing the reflux,and as a result RL and RTH had significant influence on AR,P values were 0.001,0.011.③The ROC curve analysis showed that the area of RL or RTH curve were both greater than 0.5,which were 0.811 and 0.605 respectively.Conclusions The free edge length and free edge length/height ratio have changed unbalanced.Furthermore,right coronary valve parameters changed significantly,and this might be one of the possible mechanism of AR. Key words: Echocardiography, transesophageal; Aortic valve insufficiency; Aortic valve

Exercise echocardiography predicts postoperative left ventricular remodeling in aortic regurgitation

Objective. We aimed to investigate if preoperative left ventricular (LV) function assessed by exercise echocardiography could predict late postoperative LV function in aortic regurgitation (AR) patients and to evaluate how LV long-axis function is affected late after aortic valve surgery. Design. A total of 21 male chronic AR patients, aged 49 () years, accepted for surgery were examined preoperatively, 6 months-, and 4 years postoperatively, at rest and during exercise. Besides conventional echocardiographic parameters, the atrioventricular plane displacement (AVPD) by M-mode and peak systolic velocity (s’) in the basal LV by color tissue Doppler were measured. Results. Preoperatively EFrest and EFexercise, were 55()% and 54()%, respectively, and ∆EF 0()%. LV dimensions and volumes indexed to BSA had decreased at the 6-month follow-up and were stable at late follow-up. s'rest, s'exercise, AVPDrest, and AVPDexercise were unchanged at both the postoperative examinations (all P ≥ 0.05). Preoperative EFexercise and AVPDexercise showed inverse correlation to late postoperative indexed LV enddiastolic volume (r = –0.68, p < 0.004 and r = –0.86, P < 0.001) and indexed LV endsystolic volume (r = –0.68, P = 0.004 and r = –0.81, P < 0.001), while there was no correlation to preoperative EFrest and AVPDrest (all r < 0.2). Conclusions. Preoperative exercise echocardiography can detect AR patients with suboptimal LV remodeling late postoperatively.

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

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.