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Different responses of the myocardial contractility by layer following acute pressure unloading in severe aortic stenosis patients

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Abstract

The present study evaluated change in left ventricle (LV) biomechanics, layer-by-layer, following acute pressure unloading in patients with severe aortic stenosis (AS). In twenty-eight consecutive patients with severe AS who underwent transcatheter aortic valve replacement (TAVR), LV peak global longitudinal and circumferential strains of the endo-, midmyo- and epicardium were evaluated using multilayer speckle tracking echocardiography before, 1 week after, and 1 month after TAVR. Longitudinal and circumferential strains were significantly highest in the endocardium and lowest in the epicardium at baseline. At 1 month following TAVR, longitudinal strain significantly improved in all layers compared with the baseline [endocardium (%) −16.7 ± 3.8 vs. −18.6 ± 3.3, P = 0.01; mid-myocardium −14.4 ± 3.2 vs. −16.2 ± 3.5, P < 0.01; epicardium −12.4 ± 2.8 vs. −13.6 ± 2.6, P = 0.01], whereas LV ejection fraction and circumferential strain remained unchanged. Importantly, only those with LV hypertrophy demonstrated improved longitudinal strain [endocardium (%) −15.7 ± 3.0 vs. −18.7 ± 2.9, P < 0.01; mid-myocardium −13.6 ± 2.7 vs. −16.0 ± 2.5, P < 0.01; epicardium −11.8 ± 2.4 vs. −13.7 ± 2.3, P < 0.01]. The improvement in longitudinal strain was more prominent in the endocardium, which was evident even at an early time point (1 week) after TAVR. Longitudinal strain significantly improved in all three layers following acute pressure unloading, the most prominent of which was observed in the endocardium. Evaluation of multilayer strain may provide new insights into the LV mechanics in the future.

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Abbreviations

AS:

Aortic stenosis

AV:

Aortic valve

AVA:

Aortic valve area

AR:

Aortic regurgitation

CW:

Continuous wave

EF:

Ejection fraction

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

ICC:

Intraclass correlation coefficient

IVSd:

Inter-ventricular septal thickness

LV:

Left ventricle

LVEDD:

LV end-diastolic diameter

LVESD:

LV end-systolic diameter

LVH:

LV hypertrophy

LVPWd:

LV posterior wall thickness at diastole

LVMI:

LV mass index

PG:

Pressure gradient

SD:

Standard deviation

TAVR:

Transcatheter aortic valve replacement

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Acknowledgments

We thank Sun-Jin Kim, RN, RDCS and Tae-Kyeong Lee, RN for their help in taking care of the database and Mi-Kyeong Hong, RDCS for her help in analyzing the strain data.

Grants

This study was supported by an unrestricted grant from Yuhan pharmaceuticals (Grant No. 0620140450).

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Authors and Affiliations

  1. Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Hyun-Jin Kim, Seung-Pyo Lee, Chan Soon Park, Jun-Bean Park, Yong-Jin Kim, Hyung-Kwan Kim & Dae-Won Sohn

  2. Department of Cardiology, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do, 412-270, South Korea

    Hyun-Jin Kim

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  1. Hyun-Jin Kim
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Correspondence to Seung-Pyo Lee.

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Kim, HJ., Lee, SP., Park, C.S. et al. Different responses of the myocardial contractility by layer following acute pressure unloading in severe aortic stenosis patients. Int J Cardiovasc Imaging 32, 247–259 (2016). https://doi.org/10.1007/s10554-015-0759-y

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  • DOI: https://doi.org/10.1007/s10554-015-0759-y

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