1Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Herz- und Gefäßchirurgie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Kardiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland
Objectives
Surgical intervention for severe aortic valve regurgitation (AR) is typically guided by symptoms and conventional echocardiographic parameters such as left ventricular ejection fraction (LVEF) and end-systolic diameter (LVESD), as recommended by guidelines. However, LV remodeling occurs before the onset of symptoms and decline of LVEF. The aim of this study was to evaluate the diagnostic efficacy of speckle-tracking echocardiography (STE) to optimize the surgical timing evaluation for AR.
Methods
We included 91 patients, who underwent elective aortic valve repair (AVR) for AR from 2016 to 2021 with high quality echocardiograms. Transthoracic echocardiography, including STE were performed pre-, postoperatively, at 3-month (FU3m), and 1 year follow-up (FU1y). Patients were stratified based on baseline global longitudinal strain (GLS) into normal GLS group (GLS≤-18%, n=42) and impaired GLS group (GLS>-18%, n=49). A subgroup analysis was performed in patients with preserved EF at baseline (>55%; n=45) and were divided in normal (n=24) and impaired GLS groups (n=21).
Results
Baseline characteristics, including NYHA classification and LV chamber quantification were similar in both groups. Baseline EF was not significantly (normal vs. impaired GLS group: 55.6±2.5% vs. 54.1±5.4%, p=0.083). However, postoperative EF was significantly better in the normal GLS group (52.6±5.0% vs. 42.9±7.6%, p<0.001). At FU3m and FU1y, EF recovered without significant difference between the two groups, but the normal GLS group consistently showed a superior GLS (FU3m: -17.4±2.1% vs. -15.8±3.2%, p=0.047; FU1y: -19.0±2.5% vs. -16.2±3.4%, p=0.003). Furthermore, in a subgroup analysis of patients with preserved EF at baseline, the normal GLS group had an even lower EF preoperatively (57.3±1.6% vs. 58.8±2.7%, p=0.036), but postoperatively maintained a significantly better EF (53.8±5.2% vs. 44.6±7.3%, p<0.001). Postoperatively, a better GLS was observed in the normal GLS group compared to the impaired GLS group (-17.1±3.4% vs. -12.6±2.7%, p<0.001) with more favorable changes in indexed LVESD (18.8±3.3 vs. 21.1±3.3mm, p=0.027).
Conclusion
Treating severe AR with preserved GLS reduces the risk of cardiac performance decline after AVR. The superior capabilities of GLS to detect early myocardial dysfunction, often before changes in EF. This underscores its potential as a valuable tool for decision making regarding the optimal timing of surgery in patients with AR.