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Ventricular mechanics in patients with aortic valve disease: longitudinal, radial, and circumferential components

Published online by Cambridge University Press:  07 February 2013

Benedetta Leonardi ,
Renee Margossian ,
Stephen P. Sanders ,
Marcello Chinali  and
Steven D. Colan
Benedetta Leonardi*
Affiliation:
Department of Cardiology, Bambino Gesù Children's Hospital, IRCCS Rome, Italy
Renee Margossian
Affiliation:
Department of Cardiology, Children's Hospital Boston, the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
Stephen P. Sanders
Affiliation:
Department of Cardiology, Children's Hospital Boston, the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
Marcello Chinali
Affiliation:
Department of Cardiology, Bambino Gesù Children's Hospital, IRCCS Rome, Italy
Steven D. Colan
Affiliation:
Department of Cardiology, Children's Hospital Boston, the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
*
Correspondence to: Dr B. Leonardi, MD, Department of Cardiology, Bambino Gesù Children's Hospital Rome, Piazza Sant'Onofrio, 4, 00165 Rome, Italy. Tel: 0039-06-68592822; Fax: 0039-06-68592607; E-mail: benedetta.leonardi@opbg.net
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Abstract

Background

Reduced long-axis shortening despite enhanced global function has been reported in aortic stenosis. We sought to improve the understanding of this phenomenon using multi-dimensional strain analysis in conjunction with the evaluation of left ventricular rotation and twist – ventricular torsion – using tissue Doppler techniques.

Methods

A total of 57 patients with variable severity of aortic stenosis, aortic regurgitation, or mixed aortic valve disease, subdivided into six groups, were studied. Ventricular morphology was assessed using long-axis/short-axis and mass/volume ratios, afterload using end-systolic meridional wall stress, and global performance using ejection fraction. The circumferential and longitudinal strain was measured from two-dimensional images, and left ventricular rotation and twist were estimated as the difference in rotation between the base and apex of the ventricle.

Results

Aortic stenosis was associated with higher mass/volume, ejection fraction, circumferential strain and left ventricular rotation and twist, significantly lower end-systolic wall stress, and a trend towards lower longitudinal strain compared with normal. Myocardial mechanics in aortic regurgitation were normal despite ventricular dilation. Mixed aortic valve disease showed findings similar to aortic stenosis. Left ventricular rotation and twist correlated with midwall circumferential strain (r = 0.62 and p < 0.0001), endocardial circumferential strain (r = 0.61 and p < 0.0001), and end-systolic wall stress (r = 0.48 and p < 0.0001), but not with longitudinal strain (r = 0.18 and p > 0.05).

Conclusions

Myocardial mechanics are normal in patients with aortic regurgitation, independent of abnormalities in cardiac geometry. Conversely, in aortic stenosis and mixed aortic valve disease, significant alterations in the patterns of fibre shortening are found. The effects of stenosis on cardiac function seem to dominate the effect of ventricular remodelling.

Keywords

Left ventricular torsionstrain analysisechocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 1 , February 2014 , pp. 105 - 112
Copyright
Copyright © Cambridge University Press 2013 

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