Title : Chronic moderate to severe aortic regurgitation accelerates stiffness and decreases longitudinal strain of the sinus of Valsalva and the ascending aorta
Abstract:
Background Aortic regurgitation changes the loading condition of the aorta, and the changes of the longitudinal strain of the sinus of Valsalva and the ascending aorta remains unclear.The purpose of this study was to evaluate the longitudinal strain of the sinus of Valsalva and the ascending aorta in patients with chronic moderate to severe aortic regurgitation by two-dimensional speckle tracking echocardiography.
Methods One hundred and twenty-one patients with chronic moderate to severe aortic regurgitation (AR group) and 80 healthy volunteers matched by age and sex (control group) were enrolled to assess the stiffness index β of the ascending aorta, the longitudinal strain of the sinus of Valsalva and the ascending aorta. The case group were further grouped according to whether the sinus of Valsalva was dilated (defined as dilated in men >38.0 mm and in women >35.4 mm); whether the ascending aorta was dilated (defined as dilated in men >36.5 mm and in women >34.1 mm) and the number of cusps (bicuspid aortic valve and tricuspid aortic valve). The differences of stiffness index, the longitudinal strain of the sinus of Valsalva and the ascending aorta between the groups were further analyzed. The correlation of the longitudinal strain of the sinus of Valsalva and the ascending aorta with blood pressure, aortic root diameter, stroke volume index and β were analyzed and tested for reproducibility.
Results Compared with the control group, the β was significantly increased (8.53±1.99 vs. 4.42±0.51, P < 0.001), and the longitudinal strain of the sinus of Valsalva and the ascending aorta in the AR group were significantly reduced (16.59±2.46% vs. 24.03±2.58%; 19.04±2.13% vs. 25.74±3.99%, respectively, P < 0.001). In the subgroup of aortic regurgitation with dilated sinus of Valsalva and ascending aorta, the longitudinal strain of the sinus of Valsalva and the ascending aorta were significantly lower than those with normal sized sinus of Valsalva and ascending aorta (15.73±2.11% vs. 18.32±2.19%, 18.41±1.88% vs. 20.49±1.96%, respectively, P < 0.001). The longitudinal strain of ascending aorta in the bicuspid aortic valve subgroup was also lower than that in the tricuspid aortic valve subgroup (17.64±1.77% vs. 19.39±2.06%, P < 0.001). In addition, the longitudinal strain of sinus of Valsalva was negatively correlated with systolic blood pressure, pulse pressure, aortic root diameter and stroke volume index (P < 0.001), and the longitudinal strain of ascending aorta was negatively correlated with systolic blood pressure, pulse pressure, ascending aorta diameter, stroke volume index and β (P < 0.001). The longitudinal strain of the sinus of Valsalva and the ascending aorta have good reproducibility both in intraobservers and interobservers.
Conclusion The longitudinal strain of the sinus of Valsalva and the ascending aorta decreased and the stiffness index β increased in patients with chronic moderate to severe aortic regurgitation. Furthermore, the longitudinal mechanical characteristics of the sinus of Valsalva and the ascending aorta and the stiffness of the ascending aorta will deteriorate with the progressive dilation of the sinus of Valsalva and ascending aorta.
Audience Takeaway:
- In this work, we report for the first time to assess longitudinal strain of the sinus of ValSalva and the ascending aorta in patients with chronic moderate to severe aortic regurgitation via two-dimensional speckle tracking echocardiography. In particular, because of the nonlinear structure of the sinus of ValSalva wall, in order to make the longitudinal strain measurement more precise, we proposed for the first time to measure the sinus of ValSalva into four parts, and further analyzed the local and global longitudinal strain curves.
- The audience can also try this method to measure the longitudinal strain of the patient's sinus of ValSalva and ascending aorta as a way to assess changes in the elasticity of the aortic root. The method is easy to perform and is non-invasive and does not affect the patient in any way.
- Arterial stiffness is one of the earliest detectable manifestations of adverse changes in vessel wall structure and function. For some patients with significantly reduced aortic root elasticity, strain measurement may provide reference for their treatment, such as the choice of surgical method and time.
