Impact of aortic stenosis on longitudinal myocardial deformation during exercise.

[en] In aortic stenosis (AS), left ventricular (LV) adaptation to exercise has poorly been examined. Changes in LV ejection fraction may lack accuracy in identifying the presence of intrinsic myocardial impairment. AIMS: We sought to determine the impact of aortic stenosis (AS) on left ventricular (LV) longitudinal function at exercise in a series of asymptomatic patients with AS and preserved LV ejection fraction. METHODS AND RESULTS: Long-axis function was assessed at rest and at exercise by using 2D speckle tracking of myocardial deformation in 207 AS patients (aortic valve area 0.87 ± 0.19 cm²) and 43 aged-matched control subjects. When compared with control subjects, patients with AS have reduced longitudinal myocardial function at rest (-20.2 ± 2.7 vs. -15.4 ± 4.0%) and at peak exercise (-25.0 ± 3.7 vs. -16.5 ± 4.9%) (P < 0.0001 for both). Exercise changes in global longitudinal strain were correlated with changes in LV ejection in controls but not in patients with AS. Changes in LV global longitudinal strain during test were lower in AS patients with an abnormal response to exercise (-0.5 ± 2.7 vs. -1.5 ± 2.8%, P = 0.001). In multivariate analysis, a lower global longitudinal strain at rest (P = 0.04), a higher increase in mean trans-valvular pressure gradient (P < 0.001) at exercise, and smaller exercise-induced changes in global longitudinal strain (P < 0.001) were associated with an abnormal exercise test. CONCLUSION: In AS, subnormal LV function can be reliably identified by 2D strain imaging at rest and during a sub-maximal exercise. That sensitive measure of LV systolic function is depressed in AS and even more in patients having the most severe AS.

Research Center/Unit :

Service de Cardiologie

Disciplines :

General & internal medicine

Author, co-author :

Donal, Erwan

Thebault, C.

O'Connor, K.

Veillard, D.

Rosca, M.

Pierard, Luc ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation

Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie

Language :

English

Title :

Impact of aortic stenosis on longitudinal myocardial deformation during exercise.

Publication date :

12 March 2011

Journal title :

European Journal of Echocardiography

ISSN :

1525-2167

eISSN :

1532-2114

Publisher :

Harcourt Publishers Limited

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

http://ehjcimaging.oxfordjournals.org/content/12/3/235.full.pdf+html

Available on ORBi :

since 25 January 2012

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Bibliography

Vahanian A, Otto CM. Risk stratification of patients with aortic stenosis. Eur Heart J 2010;31:416-23.
Baumgartner H, Otto CM. Aortic stenosis severity: do we need a new concept? JAm Coll Cardiol 2009;54:1012-3.
Rahimtoola SH. Valvular heart disease: a perspective on the asymptomatic patient with severe valvular aortic stenosis. Eur Heart J 2008;29:1783-90. (Pubitemid 352019821)
Vahanian A, Baumgartner H, Bax J et al. Guidelines on the management ofvalvular heart disease: The Task Force on the Management ofValvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007;28:230-68. (Pubitemid 46276943)
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr 2009;10:1-25.
Bonow RO, Carabello BA, Chatterjee K et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writingCommittee to Revise the 1998guidelinesforthe management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardio-vascular Angiography and Interventions and the Society of Thoracic Surgeons. JAm Coll Cardiol 2006;48:e1-148.
Carabello BA. Evolution of the study of left ventricular function: everything old is new again. Circulation 2002;105:2701-3. (Pubitemid 34615137)
Carabello BA. Evaluation and management of patients with aortic stenosis. Circulation 2002;105:1746-50. (Pubitemid 34408877)
Pibarot P, Dumesnil JG. Longitudinal myocardial shortening in aortic stenosis: ready for prime time after 30 years of research? Heart 2010;96:95-6.
Lafitte S, Perlant M, Reant P et al. Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr 2009;10:414-9.
Lorell BH, Carabello BA. Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 2000;102:470-9. (Pubitemid 30490688)
Buermans HP, Paulus WJ. Iconoclasts topple adaptive myocardial hypertrophy in aortic stenosis. Eur Heart J 2005;26:1697-9. (Pubitemid 41219841)
Donal E, Bergerot C, Thibault H et al. Influence of afterload on left ventricular radial and longitudinal systolic functions: a two-dimensional strain imaging study. Eur J Echocardiogr 2009;10:914-21.
Cramariuc D, Gerdts E, Davidsen ES, Segadal L, Matre K. Myocardial deformation in aortic valve stenosis: relation to left ventricular geometry. Heart 2010;96: 106-12.
Van Pelt NC, Stewart RA, Legget ME et al. Longitudinal left ventricular contractile dysfunction after exercise in aortic stenosis. Heart 2007;93:732-8. (Pubitemid 46808278)
Garcia D, Camici PG, Durand LG et al. Impairment of coronary flow reserve in aortic stenosis.J Appl Physiol 2009;106:113-21.
Amato MC, Moffa PJ, Werner KE, Ramires JA. Treatment decision in asympto-matic aortic valve stenosis: role ofexercise testing. Heart 2001;86:381-6. (Pubitemid 32889370)
Marechaux S, Bellouin A, Polge AS et al. Clinical value of exercise Doppler echo-cardiography in patients with cardiac-valvular disease. Arch Cardiovasc Dis 2008; 101:351-60.
Marechaux S, Ennezat PV, LeJemtel TH et al. Leftventricular response to exercise in aortic stenosis: an exercise echocardiographic study. Echocardiography 2007;24: 955-9. (Pubitemid 47485651)
Leurent G, Donal E, de Place C et al. Argument for a Doppler echocardiography during exercise in assessing asymptomatic patients with severe aortic stenosis. Eur J Echocardiogr 2009;10:69-73.
Lancellotti P, Donal E, Magne J, Moonen M, O'Connor K, Daubert J-C et al. Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay. Heart 2010;96:1364-71.
Lancellotti P, Moonen M, Magne J, O'Connor K, Cosyns B, Attena E et al. Prog-nostic effect of long-axis left ventricular dysfunction and B-type natriuretic peptide levels in asymptomatic aortic stenosis. Am J Cardiol 2010;105:383-8.
Serri K, Reant P, Lafitte M, Berhouet M, Le Bouffos V, Roudaut R et al. Global and regional myocardial function quantification by two-dimensional strain: application in hypertrophic cardiomyopathy. J Am Coll Cardiol 2006;47:1175-81.
Kowalski M, Herbots L, Weidemann F, Breithardt O, Strotmann J, Davidavicius G et al. One-dimensional ultrasonic strain and strain rate imaging: a new approach to the quantitation of regional myocardial function in patients with aortic stenosis. Ultrasound Med Biol 2003;29:1085-92. (Pubitemid 37011222)
Vinereanu D, Lim PO, Frenneaux MP, Fraser AG. Reduced myocardial velocities of left ventricular long-axis contraction identify both systolic and diastolic heart failure-a comparison with brain natriuretic peptide. Eur J Heart Fail 2005;7:512-9. (Pubitemid 40732980)
Dinh W, Nickl W, Smettan J, Kramer F, Krahn T, Scheffold T et al. Global longi-tudinal strain in association to increased left ventricular mass in patients with aortic valve stenosis and normal ejection fraction: a hybrid study combining echo-cardiography and magnetic resonance imaging. Cardiovasc Ultrasound 2010;8:29.
Delgado V, Tops LF, van Bommel RJ, van der Kley F, Marsan NA, Klautz RJ et al. Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement Eur Heart J 2009;30: 3037-47.
Bauer F, Mghaieth F, Dervaux N, Donal E, Derumeaux G, Cribier A et al. Preoperative tissue Doppler imaging differentiates beneficial from detrimental left ventricular hypertrophy in patients with surgical aortic stenosis. A postopera-tive morbidity study. Heart 2008;94:1440-5.
Lancellotti P, Troisfontaines P, Toussaint AC, Pierard LA. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation 2003;108:1713-7. (Pubitemid 37243659)
Picano E, Pibarot P, Lancellotti P, Monin JL, Bonow RO. The emerging role of exercise testing and stress echocardiography in valvular heart disease. J Am Coll Cardiol 2009;54:2251-60.
Lancellotti P, Senechal M, Moonen M, Donal E, Magne J, Nellessen E et al. Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy. Eur J Echocardiogr 2009;10: 663-8.