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Increased apical rotation in patients with severe aortic stenosis assessed by three-dimensional speckle tracking imaging

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Abstract

Background

Two-dimensional (2D) speckle tracking imaging (STI) is a non-invasive method used to assess subtle changes in left ventricular (LV) function such as strain and rotational dynamics. However, 2D methodology is complicated by issues such as the out-of-plane problem inherent in short-axis imaging. In addition, circumferential rotation contributes to three-dimensional (3D) wall deformations and affects tracking accuracy. By using 3D-STI technique, we evaluated LV global longitudinal strain (GLS) and apical rotation in severe aortic stenosis (AS) patients with preserved LV ejection fraction (EF).

Methods

LV GLS and apical rotation were evaluated using 3D-STI in 20 severe AS patients (79 ± 8 years old; aortic valve area 0.7 ± 0.2 cm2) with preserved LVEF (68 ± 7%). Data were compared with those of 11 hypertensive LV hypertrophy (LVH) patients (75 ± 10 years old, EF = 66 ± 4%) and 12 controls (healthy individuals: 30 ± 14 years old, EF = 63 ± 6%).

Results

Compared with LVH patients, severe AS patients had significantly decreased values of GLS (−13.0 ± 2.4 vs. −10.4 ± 2.0%, p = 0.008). In contrast, LV rotation was significantly higher in AS than LVH patients (13.9 ± 3.0° vs. 10.8 ± 2.5°, p = 0.007). There was no significant difference in stroke volume index among three groups. In these three groups, severe AS patients had significantly decreased values of GLS [analysis of variance (ANOVA), p < 0.001] and increased LV rotation (ANOVA, p < 0.001).

Conclusions

In severe AS patients, impaired GLS existed although LVEF was preserved. However, LV rotation was increased in patients with severe AS probably to maintain the LV stroke volume.

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Authors and Affiliations

  1. Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan

    Maidar Tumenbayar, Kazuto Yamaguchi, Hiroyuki Yoshitomi, Akihiro Endo & Kazuaki Tanabe

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  1. Maidar Tumenbayar
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  2. Kazuto Yamaguchi
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  3. Hiroyuki Yoshitomi
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  4. Akihiro Endo
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  5. Kazuaki Tanabe
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Correspondence to Kazuaki Tanabe.

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Conflict of interest

Maidar Tumenbayar, Kazuto Yamaguchi, Hiroyuki Yoshitomi, Akihiro Endo, and Kazuaki Tanabe declare that they have no conflicts of interest.

Human rights statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.

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Informed consent was obtained from all patients for being included in the study.

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Tumenbayar, M., Yamaguchi, K., Yoshitomi, H. et al. Increased apical rotation in patients with severe aortic stenosis assessed by three-dimensional speckle tracking imaging. J Echocardiogr 16, 28–33 (2018). https://doi.org/10.1007/s12574-017-0347-3

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  • DOI: https://doi.org/10.1007/s12574-017-0347-3

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