Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery

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Niels Thue Olsen, Peter Søgaard, Henrik B W Larsson, Jens Peter Goetze, Christian Jøns, Rasmus Møgelvang, Olav W Nielsen, Thomas Fritz-Hansen

Objectives
The aim of this study was to test myocardial deformation imaging using speckle-tracking echocardiography for predicting outcomes in chronic aortic regurgitation.
Background
In chronic aortic regurgitation, left ventricular (LV) dysfunction must be detected early to allow timely surgery. Speckle-tracking echocardiography has been proposed for this purpose, but the clinical value of this method in aortic regurgitation has not been established.
Methods
A longitudinal study was performed in 64 patients with moderate to severe aortic regurgitation. Thirty-five patients were managed conservatively with frequent clinical visits and sequential echocardiography and followed for an average of 19 ± 8 months, while 29 patients underwent surgery for the valve lesion and were followed for 6 months post-operatively. Baseline LV function by speckle-tracking and conventional echocardiography was compared with impaired outcome after surgery (defined as persisting symptoms or persisting LV dilation [LV end-diastolic volume index =87 ml/m2] or dysfunction [LV ejection fraction <50%]) and with disease progression during conservative management (defined as development of symptoms, increase in LV volume >15%, or decrease in LV ejection fraction >10%).
Results
Reduced myocardial systolic strain, systolic strain rate, and early diastolic strain rate by speckle-tracking echocardiography was associated with disease progression during conservative management (-16.3% vs. -19.0%, p = 0.02; -1.04 vs. -1.19 s-1, p = 0.02; and 1.20 vs. 1.60 s-1, p = 0.002, respectively) and with impaired outcome after surgery (-11.5% vs. -15.6%, p = 0.01; -0.88 vs. -1.01 s-1, p = 0.04; and 0.98 vs. 1.33 s-1, p = 0.01, respectively). Conventional parameters of LV function and size (LV ejection fraction and LV end-diastolic volume index) were associated with outcome after surgery (p = 0.04 and p = 0.01, respectively) but not with outcome during conservative management (p = 0.57 and p = 0.39, respectively).
Conclusions
Speckle-tracking echocardiography is useful for the early detection of LV systolic and diastolic dysfunction in chronic aortic regurgitation.

OriginalsprogEngelsk
TidsskriftJACC - Cardiovascular Imaging
Vol/bind4
Udgave nummer3
Sider (fra-til)223-30
Antal sider8
ISSN1936-878X
DOI
StatusUdgivet - 1 mar. 2011

ID: 34065738