TY - JOUR
T1 - Association of ischemic heart disease to global and regional longitudinal strain in asymptomatic aortic stenosis
AU - Carstensen, Helle Gervig
AU - Larsen, Linnea Hornbech
AU - Hassager, Christian
AU - Kofoed, Klaus Fuglsang
AU - Jensen, Jan Skov
AU - Møgelvang, Rasmus
PY - 2015/11/18
Y1 - 2015/11/18
N2 - Longitudinal deformation has been shown to deteriorate with progressive aortic stenosis as well as ischemic heart disease. Despite that both conditions share risk factors and are often coexisting, studies have not assessed the influence on longitudinal deformation for both conditions simultaneously. Thus the purpose of this study was to evaluate the association between subclinical ischemic heart disease and global and regional longitudinal strain in asymptomatic patients with significant aortic stenosis. Prevalent patients with a diagnosis of aortic stenosis at six hospitals in the Greater Copenhagen area were screened for inclusion. A total of 104 asymptomatic patients with moderate-severe aortic stenosis (aortic valve area ≤1.5 cm(2)) fulfilled study criteria and underwent advanced echocardiographic analysis and coronary angiography by multi-detector computed tomography. Angiography revealed coronary stenosis >50% in 31% (n = 32). All regional longitudinal strain measures (apical, mid and basal longitudinal strain) were significant predictors of significant coronary stenosis (>70% stenosis), but only apical and mid longitudinal strain were significant predictors in multivariable analyses independent of aortic valve area, stroke volume index, pro-BNP, valvulo-arterial impedance, body mass index and heart rate. In linear regression models with both aortic valve area and significant coronary stenosis, apical (p < 0.001) and mid (p < 0.01) longitudinal strain were associated to significant coronary stenosis but not aortic valve area. Conversely, basal longitudinal strain was significantly associated to aortic valve area (p = 0.001), but not to significant coronary stenosis. Subclinical coronary artery disease is frequent in moderate and severe aortic stenosis, and should be suspected when regional longitudinal dysfunction is predominant in the apical and mid ventricular segments.
AB - Longitudinal deformation has been shown to deteriorate with progressive aortic stenosis as well as ischemic heart disease. Despite that both conditions share risk factors and are often coexisting, studies have not assessed the influence on longitudinal deformation for both conditions simultaneously. Thus the purpose of this study was to evaluate the association between subclinical ischemic heart disease and global and regional longitudinal strain in asymptomatic patients with significant aortic stenosis. Prevalent patients with a diagnosis of aortic stenosis at six hospitals in the Greater Copenhagen area were screened for inclusion. A total of 104 asymptomatic patients with moderate-severe aortic stenosis (aortic valve area ≤1.5 cm(2)) fulfilled study criteria and underwent advanced echocardiographic analysis and coronary angiography by multi-detector computed tomography. Angiography revealed coronary stenosis >50% in 31% (n = 32). All regional longitudinal strain measures (apical, mid and basal longitudinal strain) were significant predictors of significant coronary stenosis (>70% stenosis), but only apical and mid longitudinal strain were significant predictors in multivariable analyses independent of aortic valve area, stroke volume index, pro-BNP, valvulo-arterial impedance, body mass index and heart rate. In linear regression models with both aortic valve area and significant coronary stenosis, apical (p < 0.001) and mid (p < 0.01) longitudinal strain were associated to significant coronary stenosis but not aortic valve area. Conversely, basal longitudinal strain was significantly associated to aortic valve area (p = 0.001), but not to significant coronary stenosis. Subclinical coronary artery disease is frequent in moderate and severe aortic stenosis, and should be suspected when regional longitudinal dysfunction is predominant in the apical and mid ventricular segments.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve Stenosis
KW - Asymptomatic Diseases
KW - Coronary Angiography
KW - Coronary Artery Disease
KW - Coronary Stenosis
KW - Denmark
KW - Echocardiography, Doppler
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Multidetector Computed Tomography
KW - Multimodal Imaging
KW - Myocardial Contraction
KW - Predictive Value of Tests
KW - Prevalence
KW - Prospective Studies
KW - Risk Factors
KW - Severity of Illness Index
KW - Stress, Mechanical
KW - Ventricular Dysfunction, Left
KW - Ventricular Function, Left
U2 - 10.1007/s10554-014-0572-z
DO - 10.1007/s10554-014-0572-z
M3 - Journal article
C2 - 25404082
SN - 1569-5794
VL - 31
SP - 485
EP - 495
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
IS - 3
ER -