Circumferential Strain Of Ascending Aortic And Carotid Artery In Patients With Aortic Stenosis By Two-dimensional Speckle Tracking Echocardiography

Objective:To evaluate the circumferential strain of ascending aortic（AACS）and carotid artery（CACS）in patients with aortic stenosis（AS）via two-dimensional speckle tracking echocardiography（2D-STE）.The correlation between AACS and CACS in patients with aortic stenosis was further explored.Methods:Totally 120 patients who have been diagnosed with AS by echocardiography were continuously collected from May 2021 to December 2022 in the second affiliated hospital of Dalian Medical University.Thirty AS patients were excluded due to accompanied with other hemodynamically significant valve diseases,ten were excluded due to poor image quality,and others were enrolled and divided into two groups:group A（mild as,n=20）and group B（moderate to severe as,n=60）according to the severity of stenosis;another 100 healthy volunteers were collected,20 of whom were excluded due to poor image quality.80 gender and age matched individuals were selected as the control group C.Exclusion criteria included:patients with uncontrolled atrial arrhythmias,renal failure,congenital or acquired aortic disease,history of previous cardiac surgery,hemodynamically significant valvular disease other than AS,severe hypertension and poor image quality,etc.The clinical information were recorded including name,age,sex,height,weight,body surface area（BSA）,body mass index（BMI）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,and pulse pressure（PP）.General two dimensional parameters including left ventricular end diastolic diameter（LVEDd）,left ventricular end systolic diameter（LVESd）,left ventricular end diastolic volume（LVEDV）,left ventricular end systolic volume（LVESV）,and the diameter of common carotid in end diastole（CAD_s）and end systole（CAD_d）were measured.The stroke volume index（SVI）,left ventricular mass index（LVMI）,aortic valve area（AVA）,systemic arterial compliance（SAC）,systemic vascular resistance（SVR）,valvular arterial impedance（ZVA）,ascending aortic distensibility（D）and vascular stiffness（β₂）were calculated according to the formula.The CS of ascending aorta（AACS）and carotid artery（CACS）was assessed via 2D-STE.The correlations between AVA and AACS,ascending aorta distensibility（D）,vascular stiffness（β₂）,CACS,carotid artery distensibility（D）and vascular stiffness（β₂）were evaluated and the correlation between AACS and CACS was further explored.Results:1.There were no significant difference in age,sex,height,weight,DBP and other clinical information between Group AS and the control group（P<0.05）,except for BSA,BMI,SBP and PP（P<0.05）.2.The vascular stiffness index of the ascending aorta and carotid artery,BSA,BMI,PP,SAC,SVR,ZVA,LVMI,in AS group were significantly higher than those in the control group;SVI,SAC,AACS,D and CACS,D in AS group were significantly lower than those in the control group（P<0.05）.BSA,BMI,PP,SVR,ZVA,LVMI,LVAI,β₂in group A were significantly lower than those in group B;SAC,D,AACS,CACS were significantly higher than those in group B（P<0.05）.3.Correlation analysis showed that AVA was negatively correlated with age,ZVA,SVR,VTI,LVMI,ascending aortaβ₂and Carotid arteryβ₂（r=-0.28,-0.32,-0.47,-0.68,-0.60,-0.64,-0.35,-0.68,-0.63,P<0.05）,whereas positively correlated with PP,SVI,SAC,LAVI,ascending aorta distensibility（D）,carotid distensibility（D）,AACS and CACS（r=0.44,0.58,0.63,0.36,0.60,0.61,0.54,0.46,0.45,P<0.05）;CACS was negatively correlated with age,VTI,ZVA,SVR,LVMI,AOD_d,ascending aortaβ₂and Carotid arteryβ₂（r=-0.35,-0.33,-0.32,-0.46,-0.35,-0.36,-0.35,-0.39,P<0.05）,whereas positively correlated with SVI,SAC,AOD_s,ascending aorta dilatation（D）carotid artery dilatation（D）and AACS（r=0.41,0.34,0.40,0.36,0.33,0.54,P<0.05）.Conclusion:1.Compared with the control group,AACS and CACS and distensibility（D）in the AS group were significantly decreased,and the stiffness indexβ₂of the ascending aortic and carotid artery were significantly increased.2.There was a correlation between the degree of aortic stenosis,ZVA,SAC,SVR,distensibility（D）,the stiffness indexβ₂,CACS and AACS,and there were also significant correlations between carotid artery dilatation（D）,β₂,CACS and AACS.3.The decreasing AACS together with CACS involved in the development of AS.CACS may be a meaningful monitoring indicator for clinical decision-making and follow-up management in AS patients.