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Myocardial function in aortic stenosis--insights from radial multilayer Doppler strain.

Cramariuc D, Gerdts E, Hjertaas JJ, Cramariuc A, Davidsen ES, Matre K - Cardiovasc Ultrasound (2015)

Bottom Line: Radial strain was lower in the subepicardial layer (33.4 ± 38.6%) compared to the mid-myocardial and subendocardial layers (50.3 ± 37.3% and 53.0 ± 40.0%, respectively, both p < 0.001 vs. subepicardial).In the subendo- and midmyocardium, radial strain was lower in patients with severe AS compared to those with non-severe AS (p < 0.05).In multivariate regression analyses including age, heart rate, inferior wall thickness, hypertension, and AS severity, radial strain in the mid-myocardium was primarily attenuated by presence of hypertension (β = -0.23) and AS severity (β = -0.26, both p < 0.05), while radial strain in the subendocardium was significantly influenced by AS severity only (β = -0.35, p < 0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. cramariuc_dana@yahoo.com.

ABSTRACT

Background: Left ventricular (LV) radial tissue Doppler imaging (TDI) strain increases gradually from the subepicardial to the subendocardial layer in healthy individuals. A speckle tracking echocardiography study suggested this gradient to be reduced in parallel with increasing aortic stenosis (AS) severity.

Methods: We used TDI strain in 84 patients with AS (mean age 73 ± 10 years, 56% hypertensive) for superior assessment of layer strain. 38 patients had non-severe and 46 severe AS by aortic valve area corrected for pressure recovery. Peak systolic radial TDI strain was measured in the subendocardial, mid-myocardial and subepicardial layers of the basal inferior LV wall, each within a region of interest of 2 × 6 mm (strain length 2 mm).

Results: Radial strain was lower in the subepicardial layer (33.4 ± 38.6%) compared to the mid-myocardial and subendocardial layers (50.3 ± 37.3% and 53.0 ± 40.0%, respectively, both p < 0.001 vs. subepicardial). In the subendo- and midmyocardium, radial strain was lower in patients with severe AS compared to those with non-severe AS (p < 0.05). In multivariate regression analyses including age, heart rate, inferior wall thickness, hypertension, and AS severity, radial strain in the mid-myocardium was primarily attenuated by presence of hypertension (β = -0.23) and AS severity (β = -0.26, both p < 0.05), while radial strain in the subendocardium was significantly influenced by AS severity only (β = -0.35, p < 0.01).

Conclusions: In AS, both the AS severity and concomitant hypertension attenuate radial TDI strain in the inferior LV wall. The subendocardial radial strain is mainly influenced by AS severity, while midmyocardial radial strain is attenuated by both hypertension and AS severity.

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Related in: MedlinePlus

Measurement of peak systolic radial strain in three layers in the left ventricular inferior wall of: 1a) one normotensive patient with non-severe aortic stenosis; 1b) one normotensive patient with severe aortic stenosis; 1c) one hypertensive patient with severe aortic stenosis. Each panel: Top left – Colour TDI image in parasternal short-axis view of the inferior left ventricular wall. Bottom left – B-mode image with 3 regions of interest placed in three layers (subendocardium, mid-myocardium, subepicardium) in the left ventricular inferior wall. Right panel: corresponding peak systolic radial strain curves for the three regions of interest: red curve for subendocardium, blue curve for mid-myocardium, and yellow curve for subepicardium.
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Fig1: Measurement of peak systolic radial strain in three layers in the left ventricular inferior wall of: 1a) one normotensive patient with non-severe aortic stenosis; 1b) one normotensive patient with severe aortic stenosis; 1c) one hypertensive patient with severe aortic stenosis. Each panel: Top left – Colour TDI image in parasternal short-axis view of the inferior left ventricular wall. Bottom left – B-mode image with 3 regions of interest placed in three layers (subendocardium, mid-myocardium, subepicardium) in the left ventricular inferior wall. Right panel: corresponding peak systolic radial strain curves for the three regions of interest: red curve for subendocardium, blue curve for mid-myocardium, and yellow curve for subepicardium.

Mentions: TDI recordings were analyzed for strain in the subendocardial, midmyocardial and subepicardial layers of the inferior LV wall using high resolution-zoomed parasternal short-axis recordings (at the level of papillary muscles) (Figure 1), using our highly reproducible method reported in healthy subjects [7]. The inferior wall was chosen to avoid angle-induced errors in TDI-analyses and noise due to reverberations. Lateral averaging was set at maximum and radial averaging at minimum for better deformation sampling of the myocardial layers. The frame rate varied between 225 and 327/s for TDI acquisitions.Figure 1


Myocardial function in aortic stenosis--insights from radial multilayer Doppler strain.

Cramariuc D, Gerdts E, Hjertaas JJ, Cramariuc A, Davidsen ES, Matre K - Cardiovasc Ultrasound (2015)

Measurement of peak systolic radial strain in three layers in the left ventricular inferior wall of: 1a) one normotensive patient with non-severe aortic stenosis; 1b) one normotensive patient with severe aortic stenosis; 1c) one hypertensive patient with severe aortic stenosis. Each panel: Top left – Colour TDI image in parasternal short-axis view of the inferior left ventricular wall. Bottom left – B-mode image with 3 regions of interest placed in three layers (subendocardium, mid-myocardium, subepicardium) in the left ventricular inferior wall. Right panel: corresponding peak systolic radial strain curves for the three regions of interest: red curve for subendocardium, blue curve for mid-myocardium, and yellow curve for subepicardium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4340885&req=5

Fig1: Measurement of peak systolic radial strain in three layers in the left ventricular inferior wall of: 1a) one normotensive patient with non-severe aortic stenosis; 1b) one normotensive patient with severe aortic stenosis; 1c) one hypertensive patient with severe aortic stenosis. Each panel: Top left – Colour TDI image in parasternal short-axis view of the inferior left ventricular wall. Bottom left – B-mode image with 3 regions of interest placed in three layers (subendocardium, mid-myocardium, subepicardium) in the left ventricular inferior wall. Right panel: corresponding peak systolic radial strain curves for the three regions of interest: red curve for subendocardium, blue curve for mid-myocardium, and yellow curve for subepicardium.
Mentions: TDI recordings were analyzed for strain in the subendocardial, midmyocardial and subepicardial layers of the inferior LV wall using high resolution-zoomed parasternal short-axis recordings (at the level of papillary muscles) (Figure 1), using our highly reproducible method reported in healthy subjects [7]. The inferior wall was chosen to avoid angle-induced errors in TDI-analyses and noise due to reverberations. Lateral averaging was set at maximum and radial averaging at minimum for better deformation sampling of the myocardial layers. The frame rate varied between 225 and 327/s for TDI acquisitions.Figure 1

Bottom Line: Radial strain was lower in the subepicardial layer (33.4 ± 38.6%) compared to the mid-myocardial and subendocardial layers (50.3 ± 37.3% and 53.0 ± 40.0%, respectively, both p < 0.001 vs. subepicardial).In the subendo- and midmyocardium, radial strain was lower in patients with severe AS compared to those with non-severe AS (p < 0.05).In multivariate regression analyses including age, heart rate, inferior wall thickness, hypertension, and AS severity, radial strain in the mid-myocardium was primarily attenuated by presence of hypertension (β = -0.23) and AS severity (β = -0.26, both p < 0.05), while radial strain in the subendocardium was significantly influenced by AS severity only (β = -0.35, p < 0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. cramariuc_dana@yahoo.com.

ABSTRACT

Background: Left ventricular (LV) radial tissue Doppler imaging (TDI) strain increases gradually from the subepicardial to the subendocardial layer in healthy individuals. A speckle tracking echocardiography study suggested this gradient to be reduced in parallel with increasing aortic stenosis (AS) severity.

Methods: We used TDI strain in 84 patients with AS (mean age 73 ± 10 years, 56% hypertensive) for superior assessment of layer strain. 38 patients had non-severe and 46 severe AS by aortic valve area corrected for pressure recovery. Peak systolic radial TDI strain was measured in the subendocardial, mid-myocardial and subepicardial layers of the basal inferior LV wall, each within a region of interest of 2 × 6 mm (strain length 2 mm).

Results: Radial strain was lower in the subepicardial layer (33.4 ± 38.6%) compared to the mid-myocardial and subendocardial layers (50.3 ± 37.3% and 53.0 ± 40.0%, respectively, both p < 0.001 vs. subepicardial). In the subendo- and midmyocardium, radial strain was lower in patients with severe AS compared to those with non-severe AS (p < 0.05). In multivariate regression analyses including age, heart rate, inferior wall thickness, hypertension, and AS severity, radial strain in the mid-myocardium was primarily attenuated by presence of hypertension (β = -0.23) and AS severity (β = -0.26, both p < 0.05), while radial strain in the subendocardium was significantly influenced by AS severity only (β = -0.35, p < 0.01).

Conclusions: In AS, both the AS severity and concomitant hypertension attenuate radial TDI strain in the inferior LV wall. The subendocardial radial strain is mainly influenced by AS severity, while midmyocardial radial strain is attenuated by both hypertension and AS severity.

Show MeSH
Related in: MedlinePlus