Predictive Value Of Left Ventricular Myocardial Strain In Severe Aortic Stenosis And The Changes Rules After TAVR

Part ?:Evaluation on Prognostic value of asymptomatic patients with severe aortic stenosis by left ventricular myocardial strainObjective:To investigate which strain component assessed by speckle Tracking imaging technology(STI)was the most powerful predictor for major adverse cardiac events(MACE)in asymptomatic patients with severe aortic stenosis(AS).Methods:1?We enrolled 68 preserved LVEF(LVEF>50%)and asymptomatic severe AS patients,The subjects were divided into MACE group and non-MACE group according to whether MACE occurred during the follow-up period.performed routine echocardiography and left ventricular myocardial strain using 2D-STI and3D-STI.The routine echocardiographic parameters and Two dimensional left ventri-cular Global longitudinal strain(2D-LVGLS),Three dimensional left ventricular Global longitudinal strain(3D-LVGLS),Three dimensional left ventricular Global radial strain(3D-LVGRS),Three dimensional left ventricular Global circumferential strain(3D-LVGCS),Three dimensional left ventricular Global area strain(3DLVGAS)were measured and analyzed.Result:1? The median follow-up was 13 months.A total of 21 patients occurred a major adverse cardiac event until 18 months.2 ? According to univariate analysis,there were no statistically significant differences in the basic clinical data(age,sex ratio,body surface area,etc.)and echocardiographic parameters as follows: left ventricular end-diastolic diameter(LVEDD),LVEF,and left ventricular mass Index(LVMI),the ratio of E peak of mitral orifice diastolic blood flow velocity and E 'of tissue Doppler mitral annulus velocity in diastolic ventricular septal side E/e',3D-LVGCS and 3D-LVGAS between the MACE group and the non-MACE group.There were statistical differences in Vmax,mean pressure gradient(MPG),aortic valve area index(AVAI),3D-LVGES,2D-LVGLS and 3D-LVGLS between the two groups.3 ? Multivariate analysis showed that 2D-LVGLS and 3D-LVGLS were independent predictors of the occurrence of MACE,and the area under Receiver operating characteristic curve(ROC)was 0.753 and 0.851,respectively.The sensitivity and specificity of 3D-LVGLS with-14.5% as the cut-off value to predict the occurrence of MACE were 76% and 73%,respectively.4 ? Kaplan-Meier analysis showed that 3DGLS>-14.5% can be used as an indicator to predict the occurrence of major adverse cardiac events.Conclusion:3DGLS is the most robust index for predicting reaching the end point of clinical follow-up in asymptomatic severe AS patients with preserved LVEF.Part ?:Characteristics of left ventricular myocardial strain after TAVR in patients with aortic stenosis with different left ventricular ejection fractionsObjective:The characteristics of the left ventricular strain in patients with severe aortic stenosis with different left ventricular ejection fraction after transcatheter aortic valve replacement was measured by three-dimensional speckle-tracking imaging.Methods:Forty two patients with severe AS were included and divided into three groups according to preoperative LVEF: group with good ejection fraction(LVEF ? 60%),group with median ejection fraction(60% > LVEF ? 50%),and group with lower ejection fraction(LVEF < 50%).Routine echocardiography and 3D-STI examinat-ions were performed 1 week before surgery and 3 days after surgery,1 month after surgery,3 months after surgery,and 6 months after surgery.Routine echocardiography indexes,Three dimensional left ventricular Global longitudinal strain(GLS),Three dimensional left ventricular Global radial strain(GRS),Three dimensional left ventricular Global circumferential strain(GCS),Three dimensional left ventricular Global area strain(GAS)were measured,and the myocardial strain characteristics of the three groups of subjects were compared.Result:Intra-group comparison: GLS in patients with good ejection fraction was significantly improved 3 days after surgery,further improved 3 months after surgery,and had no significant change 12 months after surgery compared with 3 months before surgery;GRS and GAS were improved only 12 months after operation.There was no significant difference in GCS at each time point.GLS in the median ejection fraction group and the reduced ejection fraction group was significantly improved 3days after operation,further improved 3 months after operation,and still improved12 months after operation.GRS and GAS were significantly improved 3 months after operation,and further improved 12 months after operation.GCS improved only 12 months after surgery.Comparison between groups: The preoperative GLS,GRS,GCS and GAS of the three groups were all lower than those of the normal control group;The GLS,GRS,GCS and GAS of the three groups 12 months after operation were still lower than those of the normal control group.After 12 months,GLS in the good ejection fraction group,the median ejection fraction group and the lower ejection fraction group increased 41.39%,72.18% and58.57%,GRS 11.66%,20.23% and 18.32%,GCS 3.8%,26.80% and 19.72%,and GAS 19.33%,33.93% and 24.93%,respectively,compared with preoperative levels,respectively.Conclusion:1?3D-STI technique can accurately and sensitively evaluate the left ventricular myocardial deformation at different periods after TAVR in patients with severe AS with different ejection fractions.2?The recovery of left ventricular function after TAVR was most significant in the median ejection fraction group,followed by the reduced ejection fraction group.