Archives of the Turkish Society of Cardiology
Subclinical left ventricular systolic dysfunction in patients with severe aortic stenosis: A speckle-tracking echocardiography study [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2018; 46(1): 18-24 | DOI: 10.5543/tkda.2017.43037

Subclinical left ventricular systolic dysfunction in patients with severe aortic stenosis: A speckle-tracking echocardiography study

Betül Cengiz1, Şükrü Taylan Şahin1, Selen Yurdakul1, Serkan Kahraman1, Ayşen Bozkurt2, Saide Aytekin2
1Department of Cardiology, İstanbul Bilim University Faculty of Medicine, İstanbul, Turkey
2Department of Cardiology, İstanbul Florence Nightingale Hospital, İstanbul, Turkey


OBJECTIVE
In patients with aortic stenosis (AS), the left ventricular (LV) geometry changes due to the increased LV afterload. However, subclinical myocardial dysfunction can develop despite a normal LV ejection fraction (EF). This study was an investigation of subclinical LV systolic dysfunction in patients with severe AS with a normal LV EF using a strain imaging method, speckle-tracking echocardiography (STE), and an evaluation of its correlation with novel indices to assess the severity of AS.

METHODS
A total of 45 asymptomatic patients with severe AS and 25 age- and sex-matched controls without any cardiac disease and with preserved LV EF (EF ≥60%) were studied. In addition to performing conventional echocardiography and STE-based strain imaging, novel indices (energy loss index [ELI], valvulo-arterial impedance, systemic arterial compliance) were also measured.

RESULTS
The LV EF, and the LV end-diastolic and end-systolic diameters were similar in the 2 groups. The LV longitudinal peak systolic strain (10.66±1.15% to 19.66±2.62%; p=0.0001) and strain rate (0.32±0.07 s−1 to 1.85±0.32 s−1; p=0.0001) were significantly impaired in the study patients compared to the controls, demonstrating subclinical ventricular systolic dysfunction. A significant positive correlation was observed between the ELI and the LV strain/strain rate (r=0.45, p=0.002; r=0.55, p=0.0001, respectively).

CONCLUSION
Patients with severe AS develop subclinical LV systolic dysfunction, despite a preserved EF. Novel strain imaging-based echocardiographic techniques may provide additional data that can detect early myocardial systolic deterioration in these patients.

Keywords: Aortic stenosis, energy loss index; left ventricular strain imaging.

How to cite this article
Betül Cengiz, Şükrü Taylan Şahin, Selen Yurdakul, Serkan Kahraman, Ayşen Bozkurt, Saide Aytekin. Subclinical left ventricular systolic dysfunction in patients with severe aortic stenosis: A speckle-tracking echocardiography study. Turk Kardiyol Dern Ars. 2018; 46(1): 18-24

Corresponding Author: Saide Aytekin, Türkiye
© Copyright 2018 Archives of the Turkish Society of Cardiology
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