J Cardiovasc Ultrasound.  2015 Dec;23(4):219-227. 10.4250/jcu.2015.23.4.219.

Reduced Longitudinal Function in Chronic Aortic Regurgitation

• Lavine SJ
• Al Balbissi KA

• KMID: 2144452
• DOI: http://doi.org/10.4250/jcu.2015.23.4.219

Abstract

BACKGROUND
Chronic 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.
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 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.
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 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).
CONCLUSION
With 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.

Keyword

Aortic valve insufficiency; Left ventricular function; Left ventricular remodeling

MeSH Terms

Aortic Valve Insufficiency*
Arterial Pressure
Echocardiography, Doppler
Heart Diseases
Humans
Tricuspid Valve Insufficiency
Ventricular Function, Left
Ventricular Remodeling

Figure

• 

  Fig. 1 Individual patient values for global longitudinal strain are plotted for patients with normal function, patients with chronic AR and preserved LV ejection fraction (AR + PEF), and patients with chronic AR with reduced LV ejection fraction (AR + REF). There is a clear difference in the individual patient values for normals vs. both groups of AR patients. AR + PEF: chronic aortic regurgitation and preserved LV ejection fraction, AR + REF: chronic aortic regurgitation and reduced LV ejection fraction, LV: left ventricular.

• 

  Fig. 2 Derived tissue Doppler recordings from the proximal septum and lateral wall are shown for a patient with moderate to severe chronic AR + PEF. The time to reach peak velocity was 110 msec later for the proximal lateral wall demonstrating systolic dyssynchrony. AR + PEF: chronic aortic regurgitation and preserved left ventricular ejection fraction.

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