Reduced Longitudinal Function in Chronic Aortic Regurgitation
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Background: Chronic aortic regurgitation (AR) patients demonstrate left ventricular (LV) remodeling with increased LV massand volume but may have a preserved LV ejection fraction (EF). We hypothesize that in chronic AR, global longitudinal systolicand diastolic function will be reduced despite a preserved LV EF. Methods: We 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 heartdisease. LV volume, transmitral spectral and tissue Doppler were obtained. Myocardial velocities and their timing and longitudinalstrain of the proximal and mid wall of each of the 3 apical views were obtained. Results: As 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 strainwas 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). Peakrapid 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). Conclusion: With chronic AR, there is impaired longitudinal function despite preserved EF. Moreover, global longitudinalstrain was well correlated with noninvasive estimated LV filling pressures and pulmonary systolic arterial pressures.
Abstract
Background: Chronic aortic regurgitation (AR) patients demonstrate left ventricular (LV) remodeling with increased LV massand volume but may have a preserved LV ejection fraction (EF). We hypothesize that in chronic AR, global longitudinal systolicand diastolic function will be reduced despite a preserved LV EF. Methods: We 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 heartdisease. LV volume, transmitral spectral and tissue Doppler were obtained. Myocardial velocities and their timing and longitudinalstrain of the proximal and mid wall of each of the 3 apical views were obtained. Results: As 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 strainwas 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). Peakrapid 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). Conclusion: With chronic AR, there is impaired longitudinal function despite preserved EF. Moreover, global longitudinalstrain was well correlated with noninvasive estimated LV filling pressures and pulmonary systolic arterial pressures.
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