Different responses of the myocardial contractility by layer following acute pressure unloading in severe aortic stenosis patients

The International Journal of Cardiovascular Imaging
Hyun-Jin KimDae-Won Sohn

Abstract

The present study evaluated change in left ventricle (LV) biomechanics, layer-by-layer, following acute pressure unloading in patients with severe aortic stenosis (AS). In twenty-eight consecutive patients with severe AS who underwent transcatheter aortic valve replacement (TAVR), LV peak global longitudinal and circumferential strains of the endo-, midmyo- and epicardium were evaluated using multilayer speckle tracking echocardiography before, 1 week after, and 1 month after TAVR. Longitudinal and circumferential strains were significantly highest in the endocardium and lowest in the epicardium at baseline. At 1 month following TAVR, longitudinal strain significantly improved in all layers compared with the baseline [endocardium (%) -16.7 ± 3.8 vs. -18.6 ± 3.3, P = 0.01; mid-myocardium -14.4 ± 3.2 vs. -16.2 ± 3.5, P < 0.01; epicardium -12.4 ± 2.8 vs. -13.6 ± 2.6, P = 0.01], whereas LV ejection fraction and circumferential strain remained unchanged. Importantly, only those with LV hypertrophy demonstrated improved longitudinal strain [endocardium (%) -15.7 ± 3.0 vs. -18.7 ± 2.9, P < 0.01; mid-myocardium -13.6 ± 2.7 vs. -16.0 ± 2.5, P < 0.01; epicardium -11.8 ± 2.4 vs. -13.7 ± 2.3, P < 0.01]. The improvement in longitudinal stra...Continue Reading

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