J Cardiovasc Ultrasound.  2015 Jun;23(2):78-85. 10.4250/jcu.2015.23.2.78.

Left Ventricular Strain as Predictor of Chronic Aortic Regurgitation

• Park SH
• Yang YA
• Kim KY
• Park SM
• Kim HN
• Kim JH
• Jang SY
• Bae MH
• Lee JH
• Yang DH

• KMID: 1806915
• DOI: http://doi.org/10.4250/jcu.2015.23.2.78

Abstract

BACKGROUND
It is not well known about the implication of left ventricular (LV) strain as a predictor for mortality in patients with chronic aortic regurgitation (AR). The purpose of this study was to investigate whether global longitudinal strain measured by two-dimensional speckle-tracking echocardiography could predict long-term outcome in patients with chronic AR.
METHODS
This is a single center non-randomized retrospective observational study. The patients with chronic AR from January 2002 to December 2012 were retrospectively enrolled. Following patients were excluded; combined other significant valvular disease, previous heart surgery, aortic disease, congenital heart disease, acute AR and young age under 18 years old. Finally, 60 patients were analyzed and the LV global strain rate was measured on apical four chamber image (GS-4CH).
RESULTS
During 64 months follow-up duration, 16 patients (26.7%) were deceased and 38 patients (63.3%) underwent aortic valve replacement (AVR). Deceased group was older (69 years old vs. 51 years old, p < 0.001) and had lower longitudinal strain (-12.05 +/- 3.72% vs. -15.66 +/- 4.35%, p = 0.005). Kaplan-Meier survival curve stratified by GS-4CH showed a trend of different event rate (log rank p = 0.001). On multivariate analysis by cox proportional hazard model adjusting for age, sex, body surface area, history of atrial fibrillation, blood urea nitrogen, LV dilatation, LV ejection fraction and AVR, decreased GS-4CH proved to be an independent predictor of mortality in patients with chronic AR (hazard ratio 1.313, 95% confidence interval 1.010-1.706, p = 0.042).
CONCLUSION
GS-4CH may be a useful predictor of mortality in patient with chronic AR.

Keyword

Chronic aortic regurgitation; Left ventricular strain; Mortality

MeSH Terms

Aortic Diseases
Aortic Valve
Aortic Valve Insufficiency*
Atrial Fibrillation
Blood Urea Nitrogen
Body Surface Area
Dilatation
Echocardiography
Follow-Up Studies
Heart Defects, Congenital
Humans
Mortality
Multivariate Analysis
Observational Study
Proportional Hazards Models
Retrospective Studies
Thoracic Surgery

Figure

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  Fig. 1 Flow diagram of patients in study. AR: aortic regurgitation, AVR: aortic valve replacement.

• 

  Fig. 2 Histogram of the distribution of baseline global longitudinal strain rate on apical 4 chamber image (-14.70 ± 4.46%, range -23.9 - -6.3%, frame rate 34.63 ± 14.31/sec, heart rate).

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  Fig. 3 Receiver operating characteristic curve showing the best cutoffs for prediction of all-cause mortality in patients with chronic aortic regurgitation. GS-4CH: global strain rate on apical four chamber image, LVEF: left ventricular ejection fraction, LVEDD: left ventricular end-diastolic diameter, AUC: area under the curve, CI: confidence interval.

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  Fig. 4 Kaplan-Meier curve for all-cause mortality stratified by GS-4CH in all patients with chronic AR (A) and patients received AVR (B). GS-4CH: global strain rate on apical four chamber image, AR: aortic regurgitation, AVR: aortic valve replacement.

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