SPC365

Regional impairment of left ventricular longitudinal strain in aortic regurgitation – have we found the missing piece?

Session: Comunicações Orais (Sessão 27) - Imagem 2 - Ecocardiografia e Strain
Speaker: Joana Silva Ferreira

Congress: CPC 2022
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Comunicações Orais
FP Number: ---
Authors: Joana Silva Ferreira; Liliana Marta; João Presume; Pedro Freitas; Sara Guerreiro; João Abecasis; Carla Reis; Eduarda Horta; Regina Ribeiras; Miguel Mendes; Maria João Andrade
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Background</span></strong><span style="color:black">: Aortic regurgitation (AR) has been shown to have an impact on myocardial mechanics and recent studies have proved the value of global longitudinal strain (GLS) as an additional parameter in the assessment of disease severity and prognosis. However, a direct and localized influence of the regurgitant jet (RJ) on regional deformation has not yet been demonstrated.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Purpose</span></strong><span style="color:black">: To assess if there is a regional pattern of impairment of longitudinal strain (LS) in AR connected to the direction of the RJ, as well as its potential reversibility and prognostic impact.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods</span></strong><span style="color:black">: We studied patients (pts) with chronic moderate and severe isolated AR referred for echocardiographic evaluation. </span><span style="color:black">For each patient, we established the direction of the RJ according to the myocardial segments impacted by its turbulent portion</span><span style="color:black">. Pts were considered to have a jet-related LS reduction (JRSR) when the wall segments impacted by the jet had a relative reduction in LS of at least 30% </span><span style="color:black">compared to non-affected segments</span><span style="color:black">. Parameters of AR severity and left ventricular (LV) size and function were also assessed. For those who underwent surgical correction of AR, the postop TTE was also compared with the preop.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results</span></strong><span style="color:black">: Of the 203 AR pts screened, 80 met inclusion criteria (median age 57 years, 83% male). Mean GLS and ejection fraction (EF) were -16% and 54%, respectively. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">In 34 of the 80 pts, there was a regional reduction of 10 percentage points in the absolute value of LS in the segments impacted by the jet, compared to non-affected segments (median of -8% <em>vs</em> -18%, p&lt;0.001), corresponding to a 56% relative decrease.&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">The predominant jet directions were basal septum (44%), mid posterior and lateral</span> <span style="color:black">(24%), and basal inferior (12%). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Demographics, severity of AR and parameters of systolic and diastolic function did not significantly differ between those who had JRSR or not. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Of the 34 pts with JRSR, 20 underwent corrective surgery. In an early postop TTE, the difference in LS between the segments impacted by the jet and the non-affected segments attenuated (4.7% absolute difference <em>vs</em> 10% in the preop TTE, p=0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Pts with JRSR in the preop echo had lower rates of improvement of GLS (11 <em>vs</em> 46% of pts improved at least 2.5%, p=0.043) and a tendency towards lower rates of recovery of EF after surgery (17% <em>vs</em> 46% recovered at least 5% in EF, p=0.07).</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusion</span></strong><span style="color:black">: This study identifies an association between the parietal impact of the RJ in AR and regional LS impairment.</span> It suggests that external factors such as blood flow dynamics affect myocardial deformation. <span style="color:black">Additionally, the longstanding impact of the jet might damage the myocardium </span>to the point of limiting recovery of systolic function after corrective surgery.</span></span></p>

<p style="text-align:justify"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">This is, to our knowledge, the first reported case series showing the negative effect of the jet&rsquo;s impact on LV longitudinal function and, most importantly, on postop outcomes. Longer follow-up is needed to confirm its prognostic role.</span></span></span></p>