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Effects of increased left ventricular wall thickness on the myocardium in severe aortic stenosis with normal left ventricular ejection fraction: Two‐ and three‐dimensional multilayer speckle tracking echocardiography
Author(s) -
Cho Eun Jeong,
Park SungJi,
Kim Eun Kyoung,
Lee Ga Yeon,
Chang SungA,
Choi JinOh,
Lee SangChol,
Park Seung Woo
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13474
Subject(s) - ejection fraction , cardiology , endocardium , medicine , speckle tracking echocardiography , stenosis , coronary artery disease , stroke volume , aortic valve stenosis , heart failure
Background The aim of this study was to determine the capability of real time three‐dimensional echocardiography ( RT 3 DE ) and two‐dimensional (2D) multilayer speckle tracking echocardiography ( MSTE ) for evaluation of early myocardial dysfunction triggered by increased left ventricular ( LV ) wall thickness in severe aortic stenosis ( AS ) with normal LV ejection fraction ( EF ≥55%). Methods Conventional, RT 3D STE and 2D MSTE were performed in 45 patients (mean 68.9±9.0 years) with severe AS (aortic valve area <1 cm 2 , aortic velocity Vmax >4 m/s or mean PG >40 mm Hg) and normal left ventricular ejection fraction ( LVEF ) without overt coronary artery disease and in 18 age‐, sex‐matched healthy controls. Global longitudinal strain ( GLS ), global circumferential strain ( GCS ), global area strain ( GAS ), and global radial strain ( GRS ) were calculated using RT 3 DE and MSTE . Results The severe AS group had lower 3D GLS , GRS , GAS and 2D epicardium, and mid‐wall and endocardium GLS compared to healthy controls. In MSTE analysis, 2D LS and CS values decreased from the endocardial layer toward the epicardial layer. Severe AS patients with increased LV wall thickness had lower 3D GLS and 2D epicardium, and mid‐wall and endocardium GLS compared with severe AS patients without LV wall thickening. GLS on RT 3D STE was correlated with GLS on 2D MSTE , left ventricular mass index, LVEF , left atrial volume index, and ln NT ‐pro BNP . Conclusion RT 3 DE and 2D MSTE can be used to identify subtle contractile dysfunction triggered by increased LV wall thickness in severe AS with normal LVEF . Therefore, RT 3D STE and 2D MSTE may provide additional information that can facilitate decision‐making regarding severe AS patients with increased LV wall thickness and normal LV function.