Oral Abstract sessions * 2 D strain in aortic stenosis: clinical impact: 13/12/2013, 14:00-15:30 * Location: Bursa

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Purpose: Longitudinal function has shown to be a sensitive marker in aortic stenosis, but studies have focused on global measures.We set out to compare global and regional longitudinal function, using both color tissue Doppler imaging (TDI) and 2-dimensional speckle tracking echocardiography (2STE), in relation to severity in moderate-severe aortic stenosis (AS).Methods: We prospectively studied 246 patients with moderate-severe AS with conventional and advanced transthoracic echocardiography.Patients were divided into three groups according to severity: Asymptomatic patients with no indication of aortic valve replacement (AVR) (Controls, n=105), patients with clinical indication of AVR but preserved left ventricular ejection fraction (LVEF) ≥ 50% (AVREF≥50%, n=72), and patients with reduced LVEF , 50% and indication of AVR (AVREF,50%, n=69).Results: Compared to controls AVREF,50%, had decreased longitudinal function (Longitudinal Displacement (LD) 7.6 mm (+ 2.2) vs. 10.5 mm (+ 1.6); p , 0.001 and Global Longitudinal Strain (GLS) -11.4% (+2.7) vs. -15.6%(+2.7); p , 0.001 as well as significantly higher left ventricular mass index (LVMI) and reduced circumferential and radial function.Interestingly, when comparing AVREF≥50%, to controls there were neither significant differences regarding conventional measures of systolic function or structure, nor with regard to circumferential or radial function by 2STE.Conversely, longitudinal function was significantly reduced: LD: 8.8 mm (+ 1.9) vs. 10.5 mm (1.6); p , 0.001 and GLS: -13.8% (+3.9) vs. -15.6%(+2.7); p , 0.01.Furthermore, regional analysis revealed a pattern of reduced basal regional longitudinal strain (RLS) with relatively normal apical RLS in AVREF≥50%, compared to controls: basal segments; -11.3% (+4.4) vs. -14.8%(+3.2); p , 0.001;, apical segments; -16.5% (+6.3) vs. -16.2%(+4.3); p=0.763.By contrast, AVREF,50%, displayed impaired RLS in both basal, midventricular and apical segments.In contrast to GLS, basal RLS remained a significant predictor of indication of AVR when adjusting for age, gender, heart rate, AVA, LAVI, E/e', TAPSE, and LVMI: basal RLS pr.%: OR 1.20 (95% CI 1.06-1.37;p =0.005) and even in the subgroup with preserved LVEF: basal RLS pr.%: OR 1.23 (95% CI 1.06-1.43;p=0.008).Conclusion: Longitudinal function is associated with severity in moderate-severe AS and begins to decrease before significant changes in conventional measures of structure and systolic function emerges.Compared to GLS reduced basal RLS is an earlier marker and stronger predictor of increasing severity in AS.

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