Speckle-Tracking Echocardiography for Predicting Outcome in Chronic Aortic Regurgitation During Conservative Management and After Surgery

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• 作者：Niels Thue Olsen ; MD ; PhD^?/sup> ; ^{thueolsen@post.tele.dk} ; Peter Sogaard ; MD ; DMSc^?/sup> ; Henrik B.W. Larsson ; MD ; DMSc ; PhD^&dagger ; ; Jens Peter Goetze ; MD ; DMSc^&Dagger ; ; Christian Jons ; MD ; PhD^?/sup> ; Rasmus Mogelvang ; MD ; PhD^?/sup> ; Olav W. Nielsen ; MD ; DMSc^§ ; ; Thomas Fritz-Hansen ; MD^?/sup>
• 关键词：aortic regurgitation ; echocardiography ; heart failure ; speckle tracking ; tissue Doppler
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2011
• 出版时间：March 2011
• 年：2011
• 卷：4
• 期：3
• 页码：223-230
• 全文大小：795 K

文摘

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Objectives

The aim of this study was to test myocardial deformation imaging using speckle-tracking echocardiography for predicting outcomes in chronic aortic regurgitation.

Background

In chronic aortic regurgitation, left ventricular (LV) dysfunction must be detected early to allow timely surgery. Speckle-tracking echocardiography has been proposed for this purpose, but the clinical value of this method in aortic regurgitation has not been established.

Methods

A longitudinal study was performed in 64 patients with moderate to severe aortic regurgitation. Thirty-five patients were managed conservatively with frequent clinical visits and sequential echocardiography and followed for an average of 19 ¡À 8 months, while 29 patients underwent surgery for the valve lesion and were followed for 6 months post-operatively. Baseline LV function by speckle-tracking and conventional echocardiography was compared with impaired outcome after surgery (defined as persisting symptoms or persisting LV dilation [LV end-diastolic volume index ?7 ml/m²] or dysfunction [LV ejection fraction <50 % ]) and with disease progression during conservative management (defined as development of symptoms, increase in LV volume >15 % , or decrease in LV ejection fraction >10 % ).

Results

Reduced myocardial systolic strain, systolic strain rate, and early diastolic strain rate by speckle-tracking echocardiography was associated with disease progression during conservative management (?6.3 % vs. ?9.0 % , p = 0.02; ?.04 vs. ?.19 s^?, p = 0.02; and 1.20 vs. 1.60 s^?, p = 0.002, respectively) and with impaired outcome after surgery (?1.5 % vs. ?5.6 % , p = 0.01; ?.88 vs. ?.01 s^?, p = 0.04; and 0.98 vs. 1.33 s^?, p = 0.01, respectively). Conventional parameters of LV function and size (LV ejection fraction and LV end-diastolic volume index) were associated with outcome after surgery (p = 0.04 and p = 0.01, respectively) but not with outcome during conservative management (p = 0.57 and p = 0.39, respectively).

Conclusions

Speckle-tracking echocardiography is useful for the early detection of LV systolic and diastolic dysfunction in chronic aortic regurgitation.