Aortic Valve Disease and Vascular Mechanics: Two‐Dimensional Speckle Tracking Echocardiographic Analysis

Purpose Degenerative aortic valve disease ( AVD ) is a complex disorder that goes beyond valve itself, also undermining aortic wall. We aimed to assess the ascending aortic mechanics with two‐dimensional speckle tracking echocardiography (2DSTE) in patients with aortic regurgitation ( AR ) and hypothesized a relationship with degree of AR . Aortic mechanics were then compared with those of similarly studied healthy controls and patients with aortic stenosis ( AS ); finally, we aimed to assess the prognostic significance of vascular mechanics in AVD . Methods Overall, 73 patients with moderate‐to‐severe AR and 22 healthy subjects were enrolled, alongside a previously examined cohort (N = 45) with moderate‐to‐severe AS . Global circumferential ascending aortic strain ( CAAS ) and strain rate ( CAASR ) served as indices of aortic deformation; corrected CAAS was calculated as CAAS /pulse pressure ( PP ). Median clinical follow‐up was 438 days. Results In patients with severe (vs. moderate) AR , CAASR (1.53 ± 0.29/sec vs. 1.90 ± 0.62/sec, P < 0.05) and corrected CAAS (0.14 ± 0.06%/mmHg vs. 0.19 ± 0.08%/mmHg, P < 0.05) were significantly lower, whereas CAAS did not differ significantly. Measurers of aortic mechanics ( CAAS , corrected CAAS , CAASR ) differed significantly (all P < 0.01) in patients with AS and AR and in healthy subjects, with lower values seen in patients with AS . In follow‐up, survival rate of AVD patients with baseline CAASR >0.88/sec was significantly higher (log rank, 97.4% vs. 73.0%; P = 0.03). Conclusions Quantitative measures of aortic mechanics were lower for AS patients, suggesting a more significant derangement of aortic elastic properties. In the context of AVD , vascular mechanics assessment proved useful in gauging clinical prognosis.