Myocardial strain and symptom severity in severe aortic stenosis: insights from cardiovascular magnetic resonance

Musa, Tarique Al, Uddin, Akhlaque, Swoboda, Peter P., Garg, Pankaj ORCID:, Fairbairn, Timothy A., Dobson, Laura E., Steadman, Christopher D., Singh, Anvesha, Erhayiem, Bara, Plein, Sven, McCann, Gerald P. and Greenwood, John P. (2017) Myocardial strain and symptom severity in severe aortic stenosis: insights from cardiovascular magnetic resonance. Quantitative Imaging in Medicine and Surgery, 7 (1). pp. 38-47. ISSN 2223-4292

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Background: Symptomatic severe aortic stenosis (AS) is a class I indication for replacement in patients when left ventricular ejection fraction (LVEF) is preserved. However, symptom reporting is often equivocal and decision making can be challenging. We aimed to quantify myocardial deformation using cardiovascular magnetic resonance (CMR) in patients classified by symptom severity. Methods: Forty-two patients with severe AS referred to heart valve clinic were studied using tagged CMR imaging. All had preserved LVEF. Patients were grouped by symptoms as either “none/mild” (n=21, NYHA class I, II) or “significant” (n=21, NYHA class III, IV, angina, syncope) but were comparable for age (72.8±5.4 vs. 71.0±6.8 years old, P=0.345), surgical risk (EuroSCORE II: 1.90±1.7 vs. 1.31±0.4, P=0.302) and haemodynamics (peak aortic gradient: 55.1±20.8 vs. 50.4±15.6, P=0.450). Thirteen controls matched in age and LVEF were also studied. LV circumferential strain was calculated using inTag© software and longitudinal strain using feature tracking analysis. Results: Compared to healthy controls, patients with severe AS had significantly worse longitudinal and circumferential strain, regardless of symptom status. Patients with “significant” symptoms had significantly worse peak longitudinal systolic strain rates (−83.352±24.802%/s vs. −106.301±43.276%/s, P=0.048) than those with “no/mild” symptoms, with comparable peak longitudinal strain (PLS), peak circumferential strain and systolic and diastolic strain rates. Conclusions: Patients with severe AS who have no or only mild symptoms exhibit comparable reduction in circumferential and longitudinal fibre function to those with significant symptoms, in whom AVR is clearly indicated. Given these findings of equivalent subclinical dysfunction, reportedly borderline symptoms should be handled cautiously to avoid potentially adverse delays in intervention.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 24 Nov 2021 03:16
Last Modified: 19 Oct 2023 03:11
DOI: 10.21037/qims.2017.02.05

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