Exploratory assessment of left ventricular strain-volume loops in severe aortic valve diseases

Objectives The purpose of this study was to examine left ventricular (LV) strain (ԑ)-volume loops to provide novel insight into the haemodynamic cardiac consequences of aortic valve stenosis (AS) and aortic valve regurgitation (AR). Methods 27 participants were retrospectively recruited: AR (n = 7), AS (n = 10) and controls (n = 10). Standard transthoracic echocardiography was utilised to obtain apical 4 chamber images to construct ԑ-volume relationships were assessed by: Early systolic ԑ (ԑ_ES), slope of ԑ-volume relation during systole (Sslope), End-systolic peak ԑ (peak ԑ), Diastolic uncoupling (systolic ԑ-diastolic ԑ at same volume) during early diastole (UNCOUP_ED) and late diastole (UNCOUP_LD). ROC-curves were used to determine the ability to detect impaired LV function. Results Whilst LV ejection fraction was comparable between groups, longitudinal peak ԑ was similarly reduced compared to controls. In contrast, ԑ_ES and Sslope were lower in both pathologies compared to controls (P 0.05) to distinguish AS vs Controls, AR vs Controls and AS vs AR, respectively. Conclusions Temporal changes in ԑ-volume characteristics provide novel insight into the haemodynamic cardiac impact of AS and AR. Contrary to traditional measures (i.e. ejection fraction, peak ԑ), these novel measures successfully distinguish between the haemodynamic cardiac impact of AS and AR. This article is protected by copyright. All rights reserved.