The predictive value of left ventricular myocardium mechanics evaluation in asymptomatic patients with aortic regurgitation and preserved left ventricular ejection fraction. A long‐term speckle‐tracking echocardiographic study

Background The management of asymptomatic patients with aortic regurgitation ( AR ) and preserved left ventricular ( LV ) ejection fraction ( LVEF ) remains challenging. The purpose of the study was to assess the early changes of LV mechanics by 2D speckle‐tracking echocardiography (2D‐ STE ) in order to predict a decrease in LVEF . Methods Sixty‐seven patients (age, 47 ± 15 years) with asymptomatic moderate (n = 27) and severe AR (n = 40) with preserved LVEF were prospectively followed for about 5 years. Sixty healthy age‐matched controls were included in the study. Standard echocardiography and 2D‐ STE were performed at the baseline and follow‐up. The primary endpoint was a deterioration of the LVEF (≤50%). Results At baseline, global LV longitudinal peak systolic strain ( GLS ) and strain rate ( GLSR s) were decreased in patients with severe AR compared to controls (−18.9 ± 2.4 vs 20.0 ± 2.1%; −1.05 ± 0.19 vs −1.18 ± 0.15 1/s, P  < .05, respectively). In the moderate AR group, GLS was not different from that of the control group, but GLSR s was significantly lower than in controls. The primary endpoint was reached in 12 patients with severe AR , while this was not observed in patients with moderate AR . In multivariate analysis, GLS was an independent predictor of LVEF . According to ROC curve analysis, probability of primary endpoint occurrence was significantly greater in patients with GLS values ≥−18.5% ( AUC : 0.89, P  < .01). Conclusions The reduction of LV longitudinal deformation is a sign of early subclinical LV dysfunction. GLS is a prognostic predictor of LV dysfunction and may be potentially useful for optimal timing of surgery for patients with significant AR .