Layer-specific deformation analysis in severe aortic valve stenosis, primary mitral valve regurgitation, and healthy individuals validated against invasive hemodynamic measurements of heart function

Rine Bakkestrøm*, Nicolaj L. Christensen, Emil Wolsk, Ann Banke, Jordi S. Dahl, Mads J. Andersen, Finn Gustafsson, Christian Hassager, Jacob E. Møller

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

AIM: Speckle tracking echocardiography is considered valuable in assessing left ventricular (LV) function. The method has been refined to assess deformation in different myocardial layers, but the effect of volume vs pressure overload on this pattern is unknown. The aim was to test whether layer-specific myocardial strain (LSS) obtained by speckle tracking echocardiography exhibits different patterns in conditions with different loading conditions.

METHODS AND RESULTS: Forty patients with asymptomatic severe aortic stenosis (AS) (AVA 0.81 ± 0.15 cm 2 , LV ejection fraction [LVEF] 66% ± 7%), 43 patients with asymptomatic or mildly symptomatic significant primary mitral regurgitation (MR) (effective regurgitant orifice (ERO) 0.51 (IQR 0.37-0.67) cm 2 , LVEF 70% ± 7%), and 23 healthy individuals (LVEF 65% ± 6%) were enrolled. Echocardiography and right heart catheterization were performed in all patients. In MR, strain values in each myocardial layer (endocardial/global longitudinal strain (GLS)/epicardial) were higher (25.0% ± 3.4%/21.6% ± 2.9%/18.8% ± 2.6%) compared to healthy individuals (22.6% ± 3.2%/19.6% ± 2.9%/17.1% ± 2.6%) and AS (20.5% ± 2.8%/17.7% ± 2.5%/14.0% ± 5.6%), P < .001. All 3 groups exhibited a similar LSS pattern with highest values in the endocardial and lowest values in the epicardial layer. The epicardial-endocardial strain ratio was lower in AS (0.72 ± 0.04) than in MR (0.75 ± 0.04, P = .04). Global longitudinal strain (GLS) correlated significantly with LV wall stress (r = .39, P = .0003) but not with LV stroke work or contractility.

CONCLUSION: Layer-specific myocardial strain (LSS) patterns differed in patients with severe AS, significant MR, and healthy individuals with highest values in MR. Strain irrespective of layer assessed was associated with LV wall stress but seemed less related to contractility and unrelated to stroke work in the setting of normal LVEF.

Original languageEnglish
JournalEchocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques
Volume35
Issue number2
Pages (from-to)170-178
ISSN0742-2822
DOIs
Publication statusPublished - Feb 2018

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Mitral Valve Insufficiency
Echocardiography
Left Ventricular Function

Keywords

  • aortic stenosis
  • echocardiography
  • left ventricular function
  • mitral regurgitation
  • myocardial strain
  • Aortic Valve Stenosis/complications
  • Reproducibility of Results
  • Prospective Studies
  • Humans
  • Middle Aged
  • Ventricular Dysfunction, Left/complications
  • Male
  • Hemodynamics/physiology
  • Cardiac Catheterization/methods
  • Echocardiography/methods
  • Female
  • Aged
  • Heart Ventricles/diagnostic imaging
  • Mitral Valve Insufficiency/complications

Cite this

@article{5c0f78f7c5a44cbf921ae18f56e018d6,
title = "Layer-specific deformation analysis in severe aortic valve stenosis, primary mitral valve regurgitation, and healthy individuals validated against invasive hemodynamic measurements of heart function",
abstract = "AIM: Speckle tracking echocardiography is considered valuable in assessing left ventricular (LV) function. The method has been refined to assess deformation in different myocardial layers, but the effect of volume vs pressure overload on this pattern is unknown. The aim was to test whether layer-specific myocardial strain (LSS) obtained by speckle tracking echocardiography exhibits different patterns in conditions with different loading conditions.METHODS AND RESULTS: Forty patients with asymptomatic severe aortic stenosis (AS) (AVA 0.81 ± 0.15 cm 2 , LV ejection fraction [LVEF] 66{\%} ± 7{\%}), 43 patients with asymptomatic or mildly symptomatic significant primary mitral regurgitation (MR) (effective regurgitant orifice (ERO) 0.51 (IQR 0.37-0.67) cm 2 , LVEF 70{\%} ± 7{\%}), and 23 healthy individuals (LVEF 65{\%} ± 6{\%}) were enrolled. Echocardiography and right heart catheterization were performed in all patients. In MR, strain values in each myocardial layer (endocardial/global longitudinal strain (GLS)/epicardial) were higher (25.0{\%} ± 3.4{\%}/21.6{\%} ± 2.9{\%}/18.8{\%} ± 2.6{\%}) compared to healthy individuals (22.6{\%} ± 3.2{\%}/19.6{\%} ± 2.9{\%}/17.1{\%} ± 2.6{\%}) and AS (20.5{\%} ± 2.8{\%}/17.7{\%} ± 2.5{\%}/14.0{\%} ± 5.6{\%}), P < .001. All 3 groups exhibited a similar LSS pattern with highest values in the endocardial and lowest values in the epicardial layer. The epicardial-endocardial strain ratio was lower in AS (0.72 ± 0.04) than in MR (0.75 ± 0.04, P = .04). Global longitudinal strain (GLS) correlated significantly with LV wall stress (r = .39, P = .0003) but not with LV stroke work or contractility. CONCLUSION: Layer-specific myocardial strain (LSS) patterns differed in patients with severe AS, significant MR, and healthy individuals with highest values in MR. Strain irrespective of layer assessed was associated with LV wall stress but seemed less related to contractility and unrelated to stroke work in the setting of normal LVEF.",
keywords = "aortic stenosis, echocardiography, left ventricular function, mitral regurgitation, myocardial strain, Aortic Valve Stenosis/complications, Reproducibility of Results, Prospective Studies, Humans, Middle Aged, Ventricular Dysfunction, Left/complications, Male, Hemodynamics/physiology, Cardiac Catheterization/methods, Echocardiography/methods, Female, Aged, Heart Ventricles/diagnostic imaging, Mitral Valve Insufficiency/complications",
author = "Rine Bakkestr{\o}m and Christensen, {Nicolaj L.} and Emil Wolsk and Ann Banke and Dahl, {Jordi S.} and Andersen, {Mads J.} and Finn Gustafsson and Christian Hassager and M{\o}ller, {Jacob E.}",
year = "2018",
month = "2",
doi = "10.1111/echo.13747",
language = "English",
volume = "35",
pages = "170--178",
journal = "Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques",
issn = "0742-2822",
publisher = "Wiley-Blackwell",
number = "2",

}

Layer-specific deformation analysis in severe aortic valve stenosis, primary mitral valve regurgitation, and healthy individuals validated against invasive hemodynamic measurements of heart function. / Bakkestrøm, Rine; Christensen, Nicolaj L.; Wolsk, Emil; Banke, Ann; Dahl, Jordi S.; Andersen, Mads J.; Gustafsson, Finn; Hassager, Christian; Møller, Jacob E.

In: Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques, Vol. 35, No. 2, 02.2018, p. 170-178.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Layer-specific deformation analysis in severe aortic valve stenosis, primary mitral valve regurgitation, and healthy individuals validated against invasive hemodynamic measurements of heart function

AU - Bakkestrøm, Rine

AU - Christensen, Nicolaj L.

AU - Wolsk, Emil

AU - Banke, Ann

AU - Dahl, Jordi S.

AU - Andersen, Mads J.

AU - Gustafsson, Finn

AU - Hassager, Christian

AU - Møller, Jacob E.

PY - 2018/2

Y1 - 2018/2

N2 - AIM: Speckle tracking echocardiography is considered valuable in assessing left ventricular (LV) function. The method has been refined to assess deformation in different myocardial layers, but the effect of volume vs pressure overload on this pattern is unknown. The aim was to test whether layer-specific myocardial strain (LSS) obtained by speckle tracking echocardiography exhibits different patterns in conditions with different loading conditions.METHODS AND RESULTS: Forty patients with asymptomatic severe aortic stenosis (AS) (AVA 0.81 ± 0.15 cm 2 , LV ejection fraction [LVEF] 66% ± 7%), 43 patients with asymptomatic or mildly symptomatic significant primary mitral regurgitation (MR) (effective regurgitant orifice (ERO) 0.51 (IQR 0.37-0.67) cm 2 , LVEF 70% ± 7%), and 23 healthy individuals (LVEF 65% ± 6%) were enrolled. Echocardiography and right heart catheterization were performed in all patients. In MR, strain values in each myocardial layer (endocardial/global longitudinal strain (GLS)/epicardial) were higher (25.0% ± 3.4%/21.6% ± 2.9%/18.8% ± 2.6%) compared to healthy individuals (22.6% ± 3.2%/19.6% ± 2.9%/17.1% ± 2.6%) and AS (20.5% ± 2.8%/17.7% ± 2.5%/14.0% ± 5.6%), P < .001. All 3 groups exhibited a similar LSS pattern with highest values in the endocardial and lowest values in the epicardial layer. The epicardial-endocardial strain ratio was lower in AS (0.72 ± 0.04) than in MR (0.75 ± 0.04, P = .04). Global longitudinal strain (GLS) correlated significantly with LV wall stress (r = .39, P = .0003) but not with LV stroke work or contractility. CONCLUSION: Layer-specific myocardial strain (LSS) patterns differed in patients with severe AS, significant MR, and healthy individuals with highest values in MR. Strain irrespective of layer assessed was associated with LV wall stress but seemed less related to contractility and unrelated to stroke work in the setting of normal LVEF.

AB - AIM: Speckle tracking echocardiography is considered valuable in assessing left ventricular (LV) function. The method has been refined to assess deformation in different myocardial layers, but the effect of volume vs pressure overload on this pattern is unknown. The aim was to test whether layer-specific myocardial strain (LSS) obtained by speckle tracking echocardiography exhibits different patterns in conditions with different loading conditions.METHODS AND RESULTS: Forty patients with asymptomatic severe aortic stenosis (AS) (AVA 0.81 ± 0.15 cm 2 , LV ejection fraction [LVEF] 66% ± 7%), 43 patients with asymptomatic or mildly symptomatic significant primary mitral regurgitation (MR) (effective regurgitant orifice (ERO) 0.51 (IQR 0.37-0.67) cm 2 , LVEF 70% ± 7%), and 23 healthy individuals (LVEF 65% ± 6%) were enrolled. Echocardiography and right heart catheterization were performed in all patients. In MR, strain values in each myocardial layer (endocardial/global longitudinal strain (GLS)/epicardial) were higher (25.0% ± 3.4%/21.6% ± 2.9%/18.8% ± 2.6%) compared to healthy individuals (22.6% ± 3.2%/19.6% ± 2.9%/17.1% ± 2.6%) and AS (20.5% ± 2.8%/17.7% ± 2.5%/14.0% ± 5.6%), P < .001. All 3 groups exhibited a similar LSS pattern with highest values in the endocardial and lowest values in the epicardial layer. The epicardial-endocardial strain ratio was lower in AS (0.72 ± 0.04) than in MR (0.75 ± 0.04, P = .04). Global longitudinal strain (GLS) correlated significantly with LV wall stress (r = .39, P = .0003) but not with LV stroke work or contractility. CONCLUSION: Layer-specific myocardial strain (LSS) patterns differed in patients with severe AS, significant MR, and healthy individuals with highest values in MR. Strain irrespective of layer assessed was associated with LV wall stress but seemed less related to contractility and unrelated to stroke work in the setting of normal LVEF.

KW - aortic stenosis

KW - echocardiography

KW - left ventricular function

KW - mitral regurgitation

KW - myocardial strain

KW - Aortic Valve Stenosis/complications

KW - Reproducibility of Results

KW - Prospective Studies

KW - Humans

KW - Middle Aged

KW - Ventricular Dysfunction, Left/complications

KW - Male

KW - Hemodynamics/physiology

KW - Cardiac Catheterization/methods

KW - Echocardiography/methods

KW - Female

KW - Aged

KW - Heart Ventricles/diagnostic imaging

KW - Mitral Valve Insufficiency/complications

U2 - 10.1111/echo.13747

DO - 10.1111/echo.13747

M3 - Journal article

C2 - 29356100

AN - SCOPUS:85041715376

VL - 35

SP - 170

EP - 178

JO - Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques

JF - Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques

SN - 0742-2822

IS - 2

ER -