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Goto H, Kato K, Imori Y, Wakita M, Eguchi N, Takaoka H, Murakami T, Nagatomo Y, Isogai T, Mitsuhashi Y, Saji M, Yamashita S, Maekawa Y, Mochizuki H, Takaoka Y, Ono M, Yamaguchi T, Kobayashi Y, Asai K, Shimizu W, Yoshikawa T. Time Course of Left Ventricular Strain Assessment via Cardiovascular Magnetic Resonance Myocardial Feature Tracking in Takotsubo Syndrome. J Clin Med 2024; 13:3238. [PMID: 38892953 PMCID: PMC11172486 DOI: 10.3390/jcm13113238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Although takotsubo syndrome (TTS) is characterized by transient systolic dysfunction of the left ventricle (LV), the time course and mechanism of LV function recovery remain elusive. The aim of this study is to evaluate cardiac functional recovery in TTS via serial cardiac magnetic resonance feature tracking (CMR-FT). Methods: In this Japanese multicenter registry, patients with newly diagnosed TTS were prospectively enrolled. In patients who underwent serial cardiovascular magnetic resonance (CMR) imaging at 1 month and 1 year after the onset, CMR-FT was performed to determine the global circumferential strain (GCS), global radial strain (GRS) and global longitudinal strain (GLS). We compared LV ejection fraction, GCS, GRS and GLS at 1 month and 1 year after the onset of TTS. Results: Eighteen patients underwent CMR imaging in one month and one year after the onset in the present study. LV ejection fraction had already normalized at 1 month after the onset, with no significant difference between 1 month and 1 year (55.8 ± 9.2% vs. 58.9 ± 7.3%, p = 0.09). CMR-FT demonstrated significant improvement in GCS from 1 month to 1 year (-16.7 ± 3.4% vs. -18.5 ± 3.2%, p < 0.01), while there was no significant difference in GRS and GLS between 1 month and year (GRS: 59.6 ± 24.2% vs. 59.4 ± 17.3%, p = 0.95, GLS: -12.8 ± 5.9% vs. -13.8 ± 4.9%, p = 0.42). Conclusions: Serial CMR-FT analysis revealed delayed improvement of GCS compared to GRS and GLS despite of rapid recovery of LV ejection fraction. CMR-FT can detect subtle impairment of LV systolic function during the recovery process in patients with TTS.
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Affiliation(s)
- Hiroki Goto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (H.G.)
| | - Ken Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (H.G.)
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (Y.I.)
| | - Masaki Wakita
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (Y.I.)
| | - Noriko Eguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (H.G.)
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (H.G.)
| | - Tsutomu Murakami
- Department of Cardiovascular Medicine, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Toshiaki Isogai
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo 183-8524, Japan
| | - Yuya Mitsuhashi
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo 183-8524, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo 143-8541, Japan
| | - Satoshi Yamashita
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Hiroki Mochizuki
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Yoshimitsu Takaoka
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Masafumi Ono
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiovascular Center, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (H.G.)
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (Y.I.)
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (Y.I.)
| | - Tsutomu Yoshikawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan
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Left ventricular reverse remodeling and function by strain analysis in aortic stenosis: A CMR analysis of the EPICHEART study. Rev Port Cardiol 2021; 40:153-164. [PMID: 33676777 DOI: 10.1016/j.repc.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/16/2020] [Accepted: 06/11/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES In severe aortic stenosis (AS), the impact of aortic valve replacement (AVR) on left ventricular (LV) systolic function assessed by strain and measured by echocardiography or cardiac magnetic resonance (CMR) has been controversial. We aimed to investigate LV systolic myocardial function changes six months after AVR using global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain derived from CMR imaging. METHODS We included 39 severe AS patients (69.3±7.8 years; 61.5% male) with preserved LV ejection fraction (LVEF) who were recruited as part of the EPICHEART study and underwent successful AVR (aortic valvular area: 0.8 cm2 (IQR: 0.2) pre- to 1.8 cm2 (IQR:0.5) post-AVR). Structural and functional parameters were assessed at baseline and six months after AVR, including LV GRS, GCS and GLS analysis by CMR, using cine short-axial and two-, three-, and four-chamber long-axial view. Comparison between baseline and postoperative LV remodeling was performed using Student t-test and Wilcoxon test. RESULTS At six-month follow-up, LV mass, end-diastolic and end-systolic volumes, stroke volume, cardiac output, lateral E/e', tricuspid annular plane systolic excursion, right ventricular (RV) S wave velocity, GLS [-15.6% (IQR: 4.39) to -13.7% (IQR: 4.62)] and GCS [-17.8±3.58% to -16.1±2.94%] reduced significantly, while LVEF and GRS remained unchanged and lateral e' velocity increased. CONCLUSIONS Despite favorable reverse LV structural and diastolic functional remodeling six months following AVR, GLS and GCS assessed by CMR reduced compared to baseline, LVEF remained unchanged. The clinical utility and timing of assessment of postoperative strain changes as a marker of systolic function progression needs further research.
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Azevedo D, Mancio J, Pessoa-Amorim G, Monteiro D, Almeida N, Ladeiras-Lopes R, Faria R, Ferreira N, Vouga L, Gama Ribeiro V, Leite-Moreira A, Bettencourt N. Left ventricular reverse remodeling and function by strain analysis in aortic stenosis: A CMR analysis of the EPICHEART study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hulshof HG, van Oorschot F, van Dijk AP, Hopman MTE, George KP, Oxborough DL, Thijssen DHJ. Changes in dynamic left ventricular function, assessed by the strain-volume loop, relate to reverse remodeling after aortic valve replacement. J Appl Physiol (1985) 2019; 127:415-422. [DOI: 10.1152/japplphysiol.00190.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aortic valve replacement (AVR) leads to remodeling of the left ventricle (LV). Adopting a novel technique to examine dynamic LV function, our study explored whether post-AVR changes in dynamic LV function and/or changes in aortic valve characteristics are associated with LV mass regression during follow-up. We retrospectively analyzed 30 participants with severe aortic stenosis who underwent standard transthoracic echocardiographic assessment before AVR [88 (IQR or interquartile range: 22–143) days], post-AVR [13 (6–22) days], and during follow-up [455 (226–907) days]. We assessed standard measures of LV structure, function, and aortic valve characteristics. Novel insight into dynamic LV function was provided through a four-chamber image by examination of the temporal relation between LV longitudinal strain (ε) and volume (ε-volume loops), representing the contribution of LV mechanics to volume change. AVR resulted in immediate changes in structural valve characteristics, alongside a reduced LV longitudinal peak ε and improved coherence between the diastolic and systolic part of the ε-volume loop (all P < 0.05). Follow-up revealed a decrease in LV mass ( P < 0.05) and improvements in LV ejection fraction and LV longitudinal peak ε ( P < 0.05). A significant relationship was present between decline in LV mass during follow-up and post-AVR improvement in coherence of the ε-volume loops ( r = 0.439, P = 0.03), but not with post-AVR changes in aortic valve characteristics or LV function (all P > 0.05). We found that post-AVR improvements in dynamic LV function are related to long-term remodeling of the LV. This highlights the potential importance of assessing dynamic LV function for cardiac adaptations in vivo. NEW & NOTEWORTHY Combining temporal measures of left ventricular longitudinal strain and volume (strain-volume loop) provides novel insights in dynamic cardiac function. In patients with aortic stenosis who underwent aortic valve replacement, postsurgical changes in the strain-volume loop are associated with regression of left ventricular mass during follow-up. This provides novel insight into the relation between postsurgery changes in cardiac hemodynamics and long-term structural remodeling, but also supports the potential utility of the assessment of dynamic cardiac function.
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Affiliation(s)
- Hugo G. Hulshof
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederieke van Oorschot
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arie P. van Dijk
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T. E. Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Keith P. George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - David L. Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Dick H. J. Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Lozano Granero V, Fernández Santos S, Fernández-Golfín C, González Gómez A, Plaza Martín M, de la Hera Galarza J, Faletra F, Swaans M, López-Fernández T, Mesa D, La Canna G, Echeverría García T, Habib G, Martínez Monzonís A, Zamorano Gómez J. Sustained Improvement of Left Ventricular Strain following Transcatheter Aortic Valve Replacement. Cardiology 2019; 143:52-61. [DOI: 10.1159/000500633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/14/2019] [Indexed: 11/19/2022]
Abstract
Purpose: Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has become a widespread technique for patients with severe AS considered inoperable or high risk for open surgery. This procedure could have a positive impact in LV mechanics. The aim of the study was to evaluate the effect of TAVR on LV function recovery, as assessed by myocardial deformation parameters, both immediately and in the long term. Methods: One-hundred nineteen consecutive patients (81.2 ± 6.9 years, 50.4% female) from 10 centres in Europe with severe AS who successfully underwent TAVR with either a self-expanding CoreValve (Medtronic, Minneapolis, MN, USA) or a mechanically expanded Lotus valve (Boston Scientific, Natick, MA, USA) were enrolled in a prospective observational study. A complete echocardiographic examination was performed prior to device implantation, before discharge and 1 year after the procedure, including the assessment of LV strain using standard 2D images. Results: Between baseline and discharge, only a modest but statistically significant improvement in GLS (global longitudinal strain) could be seen (GLS% –14.6 ± 5.0 at baseline; –15.7 ± 5.1 at discharge, p = 0.0116), although restricted to patients in the CoreValve group; 1 year after the procedure, a greater improvement in GLS was observed (GLS% –17.1 ± 4.9, p < 0.001), both in the CoreValve and the Lotus groups. Conclusions: Immediate and sustained improvement in GLS was appreciated after the TAVR procedure. Whether this finding continues to be noted in a more prolonged follow-up and its clinical implications need to be assessed in further studies.
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Deng MD, Wei X, Zhang XL, Li XD, Liu GY, Zhu D, Guo YQ, Tang H. Changes in left ventricular function in patients with aortic regurgitation 12 months after transapical transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2018; 35:99-105. [PMID: 30264363 DOI: 10.1007/s10554-018-1445-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/17/2018] [Indexed: 02/05/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for high surgical risk aortic stenosis patients; in recent years, it has also been used in patients with pure/dominant aortic regurgitation (AR). This study aimed to determine the impact of transapical TAVI on left ventricle myocardial mechanics in AR patients. Thirty AR patients (70% men; mean age, 72.8 ± 4.3 years) were enrolled. Conventional echocardiography was performed on all patients before and 12 months after TAVI. Three-dimensional speckle tracking was accomplished in 20 AR patients for the evaluation of global longitudinal strain, global circumferential strain, twist, torsion, apical rotation and basal rotation. Preoperative left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), twist, torsion and apical rotation were impaired in AR patients compared with controls. Mean left ventricular (LV) end-diastolic diameter (from 62.9 ± 7.3 to 52.0 ± 6.8 mm, p < 0.001), LV end-diastolic volume (from 199.4 ± 55.0 to 130.1 ± 48.9 mL, p < 0.001), and LV mass index (179.8 ± 52.2-134.4 ± 42.5 g/m2, p = 0.001) decreased 12 months after TAVI. Interestingly, GLS (from - 17.2 ± 3.2 to - 18.9 ± 3.7, p = 0.007) and GCS (from - 23.9 ± 4.9 to - 25.7 ± 5.0, p = 0.008) improved significantly, but LVEF did not significantly improve. In terms of the rotational mechanics, twist, rotation and basal rotation remained almost unchanged, whereas apical rotation (from 7.4 ± 4.0 to 5.5 ± 3.9, p = 0.009) was significantly impaired after transapical TAVI. Our results indicate that LV function was improved in terms of myocardial deformation but worsened in terms of apical rotation 12 months after TAVI in AR patients. Three-dimensional speckle tracking echocardiography appears to be a sensitive method for detecting subtle cardiac remodeling after TAVI.
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Affiliation(s)
- Ming-Dan Deng
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Ling Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Dong Li
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Gu-Yue Liu
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Da Zhu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China.
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Fung MJ, Thomas L, Leung DY. Alterations in Layer-Specific Left Ventricular Global Longitudinal and Circumferential Strain in Patients With Aortic Stenosis: A Comparison of Aortic Valve Replacement versus Conservative Management Over a 12-Month Period. J Am Soc Echocardiogr 2018; 32:92-101. [PMID: 30236621 DOI: 10.1016/j.echo.2018.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Impairment in left ventricular (LV) systolic strain in aortic stenosis (AS) is well documented. However, alterations in layer-specific LV global longitudinal strain (GLS) and global circumferential strain (GCS) and their recovery following surgical aortic valve replacement (AVR) have not been established. The aim of this study was to examine layer-specific changes in GLS and GCS in patients with AS undergoing AVR and compare these patients with those managed conservatively over 12 months. METHODS Eighty-six patients (mean age, 68.8 ± 12 years; 60 men) with AS (19 mild, 15 moderate, and 52 severe) were prospectively recruited. Patients with coronary disease or other significant valvular disease were excluded. Forty patients (46.5%) with severe AS underwent AVR. All patients underwent baseline echocardiography. Patients managed conservatively underwent follow-up echocardiography at 12 months. Patients undergoing AVR underwent follow-up echocardiography at 1 week and 3, 6, and 12 months after AVR. RESULTS There was worsening in subendocardial but not subepicardial or transmural GLS even in mild AS (-20.9 ± 1.0% vs -20.6 ± 0.8%, P = .012). In moderate AS, worsening in subendocardial (-19.6 ± 0.9% vs -18.2 ± 1.5%, P = .003), subepicardial (-14.9 ± 1.0% vs -13.8 ± 1.2%, P = .004), and transmural (-17.1 ± 0.9% vs -15.8 ± 1.3%, P = .03) GLS and a trend toward significant worsening in subendocardial GCS (-29.8 ± 5.16% vs -27.5 ± 5%, P = .054) were seen. Conservatively managed patients with severe AS had significant worsening in subendocardial (-16.1 ± 1.6% vs -13.9 ± 2.6%, P = .021), subepicardial (-11.6 ± 1.1% vs -10.1 ± 2.1%, P = .027), and transmural (-13.6 ± 1.3% vs -11.8 ± 2.3%, P = .02) GLS and subendocardial (-24.9 ± 3.6% vs -20.8 ± 4.5%, P = .002) and transmural (-16.9 ± 1.7% vs -14.3 ± 3.5%, P = .04) GCS on follow-up. Patients after AVR demonstrated significant improvement in GLS (from 3 months) and GCS (from 6 months) in both myocardial layers. CONCLUSIONS Patients with AS managed conservatively had worsening of GLS over 12 months despite preserved LV ejection fraction, detected earliest in the subendocardial layer. GCS became progressively impaired in moderate and severe AS. Improvement in LV strain after AVR was seen earlier with GLS (from 3 months) than with GCS (from 6 months) in both myocardial layers.
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Affiliation(s)
- Matle J Fung
- Cardiology Department, Liverpool Hospital, Liverpool, Sydney, Australia; South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia.
| | - Liza Thomas
- Cardiology Department, Liverpool Hospital, Liverpool, Sydney, Australia; South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia; Cardiology Department, Westmead Hospital, Westmead, Sydney, Australia; Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Dominic Y Leung
- Cardiology Department, Liverpool Hospital, Liverpool, Sydney, Australia; South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
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Tiwari N, Patel K. Newer echocardiographic techniques for aortic-valve imaging: Clinical aids today, clinical practice tomorrow. World J Cardiol 2018; 10:62-73. [PMID: 30190799 PMCID: PMC6121002 DOI: 10.4330/wjc.v10.i8.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/22/2018] [Accepted: 06/30/2018] [Indexed: 02/06/2023] Open
Abstract
Increasing life expectancy is expected to lead to a corresponding increase in the prevalence of aortic valve disease (AVD). Further, the number of indications for transcatheter aortic valve replacement (TAVR) as a treatment option for AVD is expanding, with a growing role for echocardiography in its management. In this review we summarize the current literature on some newer echocardiographic modalities and the parameters they generate, with a particular focus on their prognostic and clinical value beyond conventional methods in the management of aortic stenosis, TAVR, and aortic regurgitation. Speckle tracking and 3D echocardiography are now increasingly being used in the management of AVD. For instance, global longitudinal strain, the best-studied speckle tracking echocardiographic parameter, can detect subtle subclinical cardiac dysfunction in patients with AVD that is not apparent using traditional echocardiographic techniques. The emerging technique of 3D full volume color Doppler echocardiography provides more accurate measurement of the severity of aortic regurgitation than 2D-proximal isovelocity surface area. These novel techniques are promising for evaluating and risk stratifying patients to optimize surgical interventions, predict recovery, and improve clinical outcomes.
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Affiliation(s)
- Nidhish Tiwari
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States.
| | - Kavisha Patel
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
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Jeffrey RR, Hamburger RF, Gooden-Ebanks J, Petersen JW. Speckle Tracking Echocardiography Identifies Impaired Longitudinal Strain as a Common Deficit in Various Cardiac Diseases. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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