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Circumferential vascular strain rate to estimate vascular load in aortic stenosis: a speckle tracking echocardiography study

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Abstract

Evaluation of vascular mechanics through two-dimensional speckle-tracking (2D-ST) echocardiography is a feasible and accurate approach for assessing vascular stiffening. Degenerative aortic stenosis (AS) is currently considered a systemic vascular disease where rigidity of arterial walls increases. To assess the circumferential ascending aorta strain rate (CAASR) in thoracic aortas of patients with AS, applying 2D-ST technology. 45 patients with indexed aortic valve areas (iAVA) ≤0.85 cm2/m2 were studied. Global CAASR served to assess vascular deformation. Clinical, echocardiographic, and non-invasive hemodynamic data were collected. A follow up (955 days) was also performed. Average age of the cohort was 76. ± 10.3 years, with gender balance. Mean iAVA was 0.43 ± 0.15 cm2/m2. Waveforms adequate for determining CAASR were found in 246 (91 %) of the 270 aortic segments evaluated, for a mean global CAASR of 0.74 ± 0.26 s−1. Both intra- and inter-observer variability of global CAASR were deemed appropriate. CAASR correlated significantly with age (r = −0.49, p < 0.01), the stiffness index (r = −0.59, p < 0.01), systemic arterial compliance and total vascular resistance. There was a significant positive correlation between CAASR, body surface area (BSA), iAVA, and a negative relationship with valvulo-arterial impedance and E/e’ ratio (r = −0.37, p = 0.01). The stiffness index was (β = −0.41, p < 0.01) independently associated with CAASR, in a model adjusted for age, BSA, iAVA and E/e’. Patients with a baseline CAASR ≤0.66 s−1 had a worse long-term outcome (survival 52.4 vs. 83.3 %, Log Rank p = 0.04). CAASR is a promising echocardiographic tool for studying the vascular loading component of patients with AS.

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References

  1. Rajamannan NM, Evans FJ, Aikawa E, Grande-Allen KJ, Demer LL et al (2011) Calcific aortic valve disease: not simply a degenerative process: a review and agenda for research from the National Heart and Lung and Blood Institute Aortic Stenosis Working Group. Executive summary: calcific aortic valve disease-2011 update. Circulation 124:1783–1791

    Article  PubMed Central  PubMed  Google Scholar 

  2. Briand M, Dumesnil JG, Kadem L, Tongue AG, Rieu R et al (2005) Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment. J Am Coll Cardiol 46:291–298

    Article  PubMed  Google Scholar 

  3. Pibarot P, Dumesnil JG (2012) Improving assessment of aortic stenosis. J Am Coll Cardiol 60:169–180

    Article  PubMed  Google Scholar 

  4. Hamilton PK, Lockhart CJ, Quinn CE, McVeigh GE (2007) Arterial stiffness: clinical relevance, measurement and treatment. Clin Sci 113:157–170

    Article  CAS  PubMed  Google Scholar 

  5. Pannier BM, Avolio AP, Hoeks A, Mancia G, Takazawa K (2002) Methods and devices for measuring arterial compliance in humans. Am J Hypertens 15:743–753

    Article  PubMed  Google Scholar 

  6. Bjallmark A, Lind B, Peolsson M, Shahgaldi K, Brodin LA et al (2010) Ultrasonographic strain imaging is superior to conventional non-invasive measures of vascular stiffness in the detection of age-dependent differences in the mechanical properties of the common carotid artery. Eur J Echocardiogr 11:630–636

    Article  PubMed  Google Scholar 

  7. Becker M, Bilke E, Kuhl H, Katoh M, Kramann R et al (2006) Analysis of myocardial deformation based on pixel tracking in two dimensional echocardiographic images enables quantitative assessment of regional left ventricular function. Heart 92:1102–1108

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Helle-Valle T, Crosby J, Edvardsen T, Lyseggen E, Amundsen BH et al (2005) New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation 112:3149–3156

    Article  PubMed  Google Scholar 

  9. Oishi Y, Mizuguchi Y, Miyoshi H, Iuchi A, Nagase N et al (2008) A novel approach to assess aortic stiffness related to changes in aging using a two-dimensional strain imaging. Echocardiography 25:941–945

    Article  PubMed  Google Scholar 

  10. Kim KH, Park JC, Yoon HJ, Yoon NS, Hong YJ et al (2009) Usefulness of aortic strain analysis by velocity vector imaging as a new echocardiographic measure of arterial stiffness. J Am Soc Echocardiogr 22:1382–1388

    Article  PubMed  Google Scholar 

  11. Vitarelli A, Giordano M, Germano G, Pergolini M, Cicconetti P et al (2010) Assessment of ascending aorta wall stiffness in hypertensive patients by tissue Doppler imaging and strain Doppler echocardiography. Heart 96:1469–1474

    Article  PubMed  Google Scholar 

  12. Teixeira R, Moreira N, Baptista R, Barbosa A, Martins R et al (2013) Circumferential ascending aortic strain and aortic stenosis. Eur Heart J Cardiovasc Imaging 14:631–641

    Article  PubMed  Google Scholar 

  13. Dubois D, Dubois E (1916) A formula to extimate the approximate surface area if height and weight are know. Arch Inter Med 17:863–871

    Article  CAS  Google Scholar 

  14. Kadem L, Dumesnil JG, Rieu R, Durand LG, Garcia D et al (2005) Impact of systemic hypertension on the assessment of aortic stenosis. Heart 91:354–361

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R et al (2008) European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 9:438–448

    Article  PubMed  Google Scholar 

  16. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E et al (2005) 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 18:1440–1463

    Article  PubMed  Google Scholar 

  17. Dubin J, Wallerson DC, Cody RJ, Devereux RB (1990) Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination. Am Heart J 120:116–123

    Article  CAS  PubMed  Google Scholar 

  18. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133

    Article  PubMed  Google Scholar 

  19. Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P (1990) Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J 11:990–996

    CAS  PubMed  Google Scholar 

  20. Garcia D, Pibarot P, Dumesnil JG, Sakr F, Durand LG (2000) Assessment of aortic valve stenosis severity: a new index based on the energy loss concept. Circulation 101:765–771

    Article  CAS  PubMed  Google Scholar 

  21. Catalano M, Lamberti-Castronuovo A, Catalano A, Filocamo D, Zimbalatti C (2011) Two-dimensional speckle-tracking strain imaging in the assessment of mechanical properties of carotid arteries: feasibility and comparison with conventional markers of subclinical atherosclerosis. Eur J Echocardiogr 12:528–535

    Article  PubMed  Google Scholar 

  22. Yuda S, Kaneko R, Muranaka A, Hashimoto A, Tsuchihashi K et al (2011) Quantitative measurement of circumferential carotid arterial strain by two-dimensional speckle tracking imaging in healthy subjects. Echocardiography 28:899–906

    Article  PubMed  Google Scholar 

  23. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 24:277–313

    Article  PubMed  Google Scholar 

  24. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  CAS  PubMed  Google Scholar 

  25. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428

    Article  CAS  PubMed  Google Scholar 

  26. Avolio A, Jones D, Tafazzoli-Shadpour M (1998) Quantification of alterations in structure and function of elastin in the arterial media. Hypertension 32:170–175

    Article  CAS  PubMed  Google Scholar 

  27. Cavalcante JL, Lima JA, Redheuil A, Al-Mallah MH (2011) Aortic stiffness: current understanding and future directions. J Am Coll Cardiol 57:1511–1522

    Article  PubMed  Google Scholar 

  28. Tsai WC, Sun YT, Liu YW, Ho CS, Chen JY et al (2013) Usefulness of vascular wall deformation for assessment of carotid arterial stiffness and association with previous stroke in elderly. Am J Hypertens 26:770–777

    Article  PubMed  Google Scholar 

  29. Petrini J, Jenner J, Rickenlund A, Eriksson P, Franco-Cereceda A et al (2014) Elastic properties of the descending aorta in patients with a bicuspid or tricuspid aortic valve and aortic valvular disease. J Am Soc Echocardiogr 27:393–404

    Article  PubMed  Google Scholar 

  30. Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P (2007) Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation 115:2856–2864

    Article  PubMed  Google Scholar 

  31. Rajani R, Chowienczyk P, Redwood S, Guilcher A, Chambers JB (2008) The noninvasive estimation of central aortic blood pressure in patients with aortic stenosis. J Hypertens 26:2381–2388

    Article  CAS  PubMed  Google Scholar 

  32. O’Rourke MF, Staessen JA, Vlachopoulos C, Duprez D, Plante GE (2002) Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens 15:426–444

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Nélson Ribeiro BSc, and Ana Paula Oliveira BSc, for their help during initial echocardiographic patient evaluations, as well as Mrs Sónia Cancela for her logistic support.

Conflict of interest

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Departamento de Medicina, Serviço de Cardiologia, Hospital Beatriz Ângelo, Avenida Carlos Teixeira – 3, 2674-514, Loures, Portugal

    Rogério Teixeira, Ricardo Monteiro & Miguel Ribeiro

  2. Faculdade de Medicina Universidade de Coimbra, Coimbra, Portugal

    Rogério Teixeira, Rui Baptista & Lino Gonçalves

  3. Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Rogério Teixeira, Rui Baptista, António Barbosa, Luís Leite, Rui Martins & Lino Gonçalves

  4. Serviço de Cardiologia, Hospital da Luz, Lisbon, Portugal

    Nuno Cardim

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  1. Rogério Teixeira
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Correspondence to Rogério Teixeira.

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Teixeira, R., Monteiro, R., Baptista, R. et al. Circumferential vascular strain rate to estimate vascular load in aortic stenosis: a speckle tracking echocardiography study. Int J Cardiovasc Imaging 31, 681–689 (2015). https://doi.org/10.1007/s10554-015-0597-y

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  • DOI: https://doi.org/10.1007/s10554-015-0597-y

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