Subendocardial left ventricular dysfunction by speckle-tracking strain image in asymptomatic patients with chronic aortic regurgitation and normal ejection fraction

Background: Aortic regurgitation (AR) is the most common valvular heart disease. During asymptomatic phase, many changes in the left ventricle (LV) geometry, volume, wall stress, and LV wall thickness eventually ends up with LV myocardium dysfunction. The traditional echocardiographic parameters utilized for the detection of myocardial dysfunction and the subsequent timing of surgery are not sensitive enough to detect these changes in their early stage before an irreversible myocardial damage occurs. Objective: the objective of this study to demonstrate the presence of global longitudinal strain (GLS) abnormality in patient with chronic asymptomatic AR reflecting a subclinical left ventricular dysfunction. Materials and Methods: A total of 35 asymptomatic patients with chronic AR of different severity and preserved ejection fraction (EF) were compared with 35 age-matched control healthy subjects. Results: There was a statistically significant reduction in the GLS values in patient with AR regardless its severity compared with control (P < 0.00), despite the preserved EF. Also decreased GLS index to LV end diastolic volume in patients with chronic AR (P < 0.00). Furthermore, they exhibited significant increase (P < 0.00) in wall thickness, end-systolic volume, and LV mass in patients compared to the control group. Conclusion: GLS measured by speckle tracking for chronic asymptomatic AR was significantly lower than normal participants and may have potential role in timing of surgery and postoperative prognosis