Aort Darlığı ve Ciddiyetinin Sol Ventrikül Fonksiyonuna Etkisinin İsovolumik Miyokardiyal Akselerasyon ile Değerlendirilmesi

Year 2020, , 154 - 160, 30.12.2020

Ertan Akbay , Mehmet Erturk , Serkan Yazan , Mustafa Umut Somuncu , Aydın Yıldırım

https://doi.org/10.18678/dtfd.731379

Abstract

Amaç: Doku Doppler kaynaklı isovolumik akselerasyon (İVA) her iki ventrikülün sistolik fonksiyonunu ön ve ard yükten etkilenmeden değerlendiren bir parametredir. Bu çalışmada asemptomatik aort darlığı (AD) olan hastalarda, sol ventrikül sistolik disfonksiyonun İVA ile erken aşamada tespiti amaçlanmıştır.
Gereç ve Yöntemler: Çalışmaya izole AD bulunan 75 hasta ve herhangi bir kapak hastalığı bulunmayan 30 hasta olmak üzere toplam 105 hasta dahil edildi. AD hastaları, transtorasik ekokardiyografi ile belirlenen aort kapak alanı (AKA) ve aortik pik velositeye göre üç gruba (hafif, orta ve ileri) ayrıldı. Konvansiyonel ekokardiyografi parametreleri, sistolik ve diyastolik doku Doppler parametreleri [isovolumik kontraksiyon esnasında oluşan pik miyokardiyal velosite (IVV), ejeksiyon fazında oluşan miyokardiyal velosite (Sm), erken diyastolik miyokardiyal velosite (e'), geç diyastolik miyokardiyal velosite (a'), akselarasyon zamanı (AT)] tüm hastalarda hesaplandı. İVA, IVV akım hızının AT süresine bölünmesiyle elde edildi.
Bulgular: Sistolik parametrelerden IVV (p<0.001), Sm (p<0.001), İVA (p=0.002) ve diyastolik parametrelerden e' dalgası (p<0.001), a' dalgası (p=0.001) AD bulunan hastalarda kontrol grubuna göre anlamlı şekilde düşük izlendi. Fakat İVA da izlenen bu ilişki AD alt gruplarında anlamlı değildi (p=0.122). Sm ve e' dalgasının, AKA ile pozitif yönde (sırasıyla p=0.001, p<0.001) aortik pik gradiyentle negatif yönde korelasyonu vardı (sırayla p=0.008, p<0.001), ancak İVA ise korele değildi.
Sonuç: AD olan kişilerde sol ventrikül fonksiyonu bozulmuştur ve bu AD ciddiyetinden bağımsızdır.

Keywords

aort darlığı, isovolumik akselerasyon, doku Doppler görüntüleme

Supporting Institution

Bulunmamaktadır

Evaluation of the Effect of Aortic Stenosis and Severity on Left Ventricular Function by Isovolumic Myocardial Acceleration

Abstract

Aim: Tissue Doppler-derived isovolumic acceleration (IVA) is a parameter that evaluates the systolic function of both ventricles, without being affected by pre-load and post-load. We aimed to detect left ventricular systolic dysfunction at an early stage with IVA in patients with asymptomatic aortic stenosis (AS).
Material and Methods: A total of 105 patients were included in the study, 75 of which had isolated AS and 30 were free of any valve disease. Patients with AS were divided into three groups (mild, moderate and severe) according to their aortic valve area (AVA) and aortic peak velocities, as determined by means of a transthoracic echocardiography. Conventional echocardiography, systolic and diastolic Tissue Doppler parameters [peak myocardial velocity during isovolumic contraction (IVV), myocardial velocity during ejection phase (Sm), early diastolic myocardial velocity (e'), late diastolic myocardial velocity (a'), and acceleration time (AT)] were calculated in all patients. IVA was obtained by dividing the IVV flow rate by the AT time.
Results: The systolic parameters IVV (p<0.001), Sm (p<0.001), IVA (p=0.002) and diastolic parameters e' wave (p<0.001), a' wave (p=0.001) were found to be significantly lower in patients with AS compared to the control group. However, this relationship observed in IVA was not different in AS subgroups (p=0.122). Sm and e' waves were positively correlated with AVA (p=0.001, p<0.001, respectively) and negatively correlated with aortic peak gradient (p=0.008, p<0.001, respectively), but IVA was not correlated.
Conclusion: Left ventricular function is impaired in patients with AS and this is independent of the severity of AS.

Keywords

aortic stenosis, isovolumic acceleration, tissue Doppler imaging

References

• Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28(2):230-68.
• Cheitlin MD, Gertz EW, Brundage BH, Carlson CJ, Quash JA, Bode Jr RS. Rate of progression of severity of valvular aortic stenosis in the adult. Am Heart J. 1979;98(6):689-700.
• Peter M, Hoffmann A, Parker C, Lüscher T, Burckhardt D. Progression of aortic stenosis. Role of age and concomitant coronary artery disease. Chest. 1993;103(6):1715-9.
• Davies SW, Gershlick AH, Balcon R. Progression of valvar aortic stenosis: a long-term retrospective study. Eur Heart J. 1991;12(1):10-4.
• Kelly TA, Rothbart RM, Cooper CM, Kaiser DL, Smucker ML, Gibson RS. Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis. Am J Cardiol. 1988;61(1):123-30.
• Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-91.
• Yingchoncharoen T, Gibby C, Rodriguez LL, Grimm RA, Marwick TH. Association of myocardial deformation with outcome in asymptomatic aortic stenosis with normal ejection fraction. Circ Cardiovasc Imaging. 2012;5(6):719-25.
• Jassal DS, Tam JW, Dumesnil JG, Giannoccaro PJ, Jue J, Pandey AS, et al. Clinical usefulness of tissue Doppler imaging in patients with mild to moderate aortic stenosis: a substudy of the aortic stenosis progression observation measuring effects of rosuvastatin study. J Am Soc Echocardiogr. 2008;21(9):1023-7.
• Lancellotti P, Donal E, Magne J, O'Connor K, Moonen ML, Cosyns B, et al. Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study. Eur J Echocardiogr. 2010;11(6):537-43.
• Bruch C, Stypmann J, Grude M, Gradaus R, Breithardt G, Wichter T. Tissue Doppler imaging in patients with moderate to severe aortic valve stenosis: clinical usefulness and diagnostic accuracy. Am Heart J. 2004;148(4):696-702.
• Steine K, Rossebø AB, Stugaard M, Pedersen TR. Left ventricular systolic and diastolic function in asymptomatic patients with moderate aortic stenosis. Am J Cardiol. 2008;102(7):897-901.
• Galema TW, Yap SC, Geleijnse ML, van Thiel RJ, Lindemans J, ten Cate FJ, et al. Early detection of left ventricular dysfunction by Doppler tissue imaging and N-terminal pro-B-type natriuretic peptide in patients with symptomatic severe aortic stenosis. J Am Soc Echocardiogr. 2008;21(3):257-61.
• Giorgi D, Di Bello V, Talini E, Palagi C, Delle Donne MG, Nardi C, et al. Myocardial function in severe aortic stenosis before and after aortic valve replacement: a Doppler tissue imaging study. J Am Soc Echocardiogr. 2005;18(1):8-14.
• Stewart RA, Kerr AJ, Whalley GA, Legget ME, Zeng I, Williams MJ, et al. Left ventricular systolic and diastolic function assessed by tissue Doppler imaging and outcome in asymptomatic aortic stenosis. Eur Heart J. 2010;31(18):2216-22.
• Lafitte S, Perlant M, Reant P, Serri K, Douard H, DeMaria A, et al. Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr. 2009;10(3):414-9.
• Li CM, Li C, Bai WJ, Zhang XL, Tang H, Qing Z, et al. Value of three-dimensional speckle-tracking in detecting left ventricular dysfunction in patients with aortic valvular diseases. J Am Soc Echocardiogr. 2013;26(11):1245-52.
• Miyazaki S, Daimon M, Miyazaki T, Onishi Y, Koiso Y, Nishizaki Y, et al. Global longitudinal strain in relation to the severity of aortic stenosis: a two-dimensional speckle-tracking study. Echocardiography. 2011;28(7):703-8.
• Vogel M, Cheung MMH, Li J, Kristiansen SB, Schmidt MR, White PA, et al. Noninvasive assessment of left ventricular force-frequency relationships using tissue Doppler-derived isovolumic acceleration: validation in an animal model. Circulation. 2003;107(12):1647-52.
• Vogel M, Schmidt MR, Kristiansen SB, Cheung M, White PA, Sorensen K, et al. Validation of myocardial acceleration during isovolumic contraction as a novel noninvasive index of right ventricular contractility: comparison with ventricular pressure-volume relations in an animal model. Circulation. 2002;105(14):1693-9.
• Dalsgaard M, Snyder EM, Kjaergaard J, Johnson BD, Hassager C, Oh JK. Isovolumic acceleration measured by tissue Doppler echocardiography is preload independent in healthy subjects. Echocardiography. 2007;24(6):572-9.
• Duan YY, Harada K, Toyono M, Ishii H, Tamura M, Takada G. Effects of acute preload reduction on myocardial velocity during isovolumic contraction and myocardial acceleration in pediatric patients. Pediatr Cardiol. 2006;27(1):32-6.
• Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22(1):1-23; quiz 101-2.
• Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57(6):450-8.
• Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63.
• Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22(2):107-33.
• Delgado V, Tops LF, van Bommel RJ, van der Kley F, Marsan NA, Klautz RJ, et al. Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement. Eur Heart J. 2009;30(24):3037-47.
• Eidet J, Dahle G, Bugge JF, Bendz B, Rein KA, Fosse E, et al. Transcatheter aortic valve implantation and intraoperative left ventricular function: a myocardial tissue Doppler imaging study. J Cardiothorac Vasc Anesth. 2015;29(1):115-20.
• Poulsen SH, Søgaard P, Nielsen-Kudsk JE, Egeblad H. Recovery of left ventricular systolic longitudinal strain after valve replacement in aortic stenosis and relation to natriuretic peptides. J Am Soc Echocardiogr. 2007;20(7):877-84.
• Nieh CC, Teo AYH, Soo WM, Lee GK, Singh D, Poh KK. Improvement in left ventricular function assessed by tissue Doppler imaging after aortic valve replacement for severe aortic stenosis. Singapore Med J. 2015;56(12):672-6.
• Kim YH, Kim JH, Park C. Evaluation of tissue Doppler ultrasonographic and strain imaging for assessment of myocardial dysfunction in dogs with type 1 diabetes mellitus. Am J Vet Res. 2018;79(10):1035-43.
• Nahar S, Ahmed CM, Shakil SS. Echocardiographic evaluation of right ventricular function in patients with type 2 diabetes mellitus. Mymensingh Med J. 2019;28(2):370-7.
• Ghandi Y, Sharifi M, Habibi D, Dorreh F, Hashemi M. Evaluation of left ventricular function in obese children without hypertension by a tissue Doppler imaging study. Ann Pediatr Cardiol. 2018;11(1):28-33.
• Erturk M, Aksu HU, Celik O, Uzun F, Akgul O, Pusuroglu H, et al. Evaluation of the effect of mitral stenosis severity on the left ventricular systolic function using isovolumic myocardial acceleration. Cardiol J. 2014;21(4):442-8.
• Barthélémy R, Roy X, Javanainen T, Mebazaa A, Chousterman BG. Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients. Crit Care. 2019;23(1):312.
• Rajani R, Rimington H, Chambers JB. Treadmill exercise in apparently asymptomatic patients with moderate or severe aortic stenosis: relationship between cardiac index and revealed symptoms. Heart. 2010;96(9):689-95.
• Jurcut R, Giusca S, La Gerche A, Vasile S, Ginghina C, Voigt JU. The echocardiographic assessment of the right ventricle: what to do in 2010? Eur J Echocardiogr. 2010;11(2):81-96.
• Orsinelli DA, Aurigemma GP, Battista S, Krendel S, Gaasch WH. Left ventricular hypertrophy and mortality after aortic valve replacement for aortic stenosis. A high risk subgroup identified by preoperative relative wall thickness. J Am Coll Cardiol. 1993;22(6):1679-83.
• Bauer F, Mghaieth F, Dervaux N, Donal E, Derumeaux G, Cribier A, et al. Preoperative tissue Doppler imaging differentiates beneficial from detrimental left ventricular hypertrophy in patients with surgical aortic stenosis. A postoperative morbidity study. Heart. 2008;94(11):1440-5.
• Poh KK, Chan MYY, Yang H, Yong QW, Chan YH, Ling LH. Prognostication of valvular aortic stenosis using tissue Doppler echocardiography: underappreciated importance of late diastolic mitral annular velocity. J Am Soc Echocardiogr. 2008;21(5):475-81.
• Truong VT, Mazur W, Palmer C, Egnaczyk GF, Kereiakes DJ, Sarembock IJ, et al. Impact of high baseline left ventricular filling pressure on transcatheter aortic valve replacement outcomes in patients with significant mitral annular calcification. J Am Soc Echocardiogr. 2019;32(9):1067-74.e1.
• Polito MV, Stoebe S, Galasso G, De Rosa R, Citro R, Piscione F, et al. Analysis of regional right ventricular function by tissue Doppler imaging in patients with aortic stenosis. J Cardiovasc Echogr. 2019;29(3):111-8.
• Gomez Perez M, Ble M, Cladellas M, Molina L, Vila J, Mas-Stachurska A, et al. Combined use of tissue Doppler imaging and natriuretic peptides as prognostic marker in asymptomatic aortic stenosis. Int J Cardiol. 2017;228:890-4.
• Henein MY, Priestley K, Davarashvili T, Buller N, Gibson DG. Early changes in left ventricular subendocardial function after successful coronary angioplasty. Br Heart J. 1993;69(6):501-6.