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Association of ischemic heart disease to global and regional longitudinal strain in asymptomatic aortic stenosis

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Abstract

Longitudinal deformation has been shown to deteriorate with progressive aortic stenosis as well as ischemic heart disease. Despite that both conditions share risk factors and are often coexisting, studies have not assessed the influence on longitudinal deformation for both conditions simultaneously. Thus the purpose of this study was to evaluate the association between subclinical ischemic heart disease and global and regional longitudinal strain in asymptomatic patients with significant aortic stenosis. Prevalent patients with a diagnosis of aortic stenosis at six hospitals in the Greater Copenhagen area were screened for inclusion. A total of 104 asymptomatic patients with moderate-severe aortic stenosis (aortic valve area ≤1.5 cm2) fulfilled study criteria and underwent advanced echocardiographic analysis and coronary angiography by multi-detector computed tomography. Angiography revealed coronary stenosis >50 % in 31 % (n = 32). All regional longitudinal strain measures (apical, mid and basal longitudinal strain) were significant predictors of significant coronary stenosis (>70 % stenosis), but only apical and mid longitudinal strain were significant predictors in multivariable analyses independent of aortic valve area, stroke volume index, pro-BNP, valvulo-arterial impedance, body mass index and heart rate. In linear regression models with both aortic valve area and significant coronary stenosis, apical (p < 0.001) and mid (p < 0.01) longitudinal strain were associated to significant coronary stenosis but not aortic valve area. Conversely, basal longitudinal strain was significantly associated to aortic valve area (p = 0.001), but not to significant coronary stenosis. Subclinical coronary artery disease is frequent in moderate and severe aortic stenosis, and should be suspected when regional longitudinal dysfunction is predominant in the apical and mid ventricular segments.

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Abbreviations

MDCT:

Multi detector computed tomography

GLS:

Global longitudinal strain

ALS:

Apical longitudinal strain

MLS:

Mid longitudinal strain

BLS:

Basal longitudinal strain

CV:

Coefficient of variation

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Acknowledgments

Alfred Helsted & Eli Moellers foundation, Th. Maigaards Lily Benthine Lunds Foundation, Jens Anker Andersen Foundation and Raimond & Dagmar Ringgaard-Bohns Foundation. The sponsors had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.

Conflict of interest

Dr. Kofoed has received lecture fees from Toshiba Medical Systems.

Author information

Authors and Affiliations

  1. Department of Cardiology, Gentofte Hospital, University Hospital of Copenhagen, Niels Andersens Vej 65, 2900, Copenhagen, Denmark

    Helle Gervig Carstensen & Jan Skov Jensen

  2. Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark

    Linnea Hornbech Larsen, Christian Hassager & Rasmus Mogelvang

  3. Department of Radiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark

    Klaus Fuglsang Kofoed

Authors
  1. Helle Gervig Carstensen
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  2. Linnea Hornbech Larsen
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  3. Christian Hassager
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  4. Klaus Fuglsang Kofoed
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  5. Jan Skov Jensen
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  6. Rasmus Mogelvang
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Correspondence to Helle Gervig Carstensen.

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Carstensen, H.G., Larsen, L.H., Hassager, C. et al. Association of ischemic heart disease to global and regional longitudinal strain in asymptomatic aortic stenosis. Int J Cardiovasc Imaging 31, 485–495 (2015). https://doi.org/10.1007/s10554-014-0572-z

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  • DOI: https://doi.org/10.1007/s10554-014-0572-z

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