The Characteristic Of Longitudinal Strain Of Ascending Aorta And Sinus Of Valsalva In Patients With Chronic Moderate To Severe Aortic Regurgitation Via Two-dimensional Speckle Tracking Echocardiography

Objective: To evaluate the characteristic of the longitudinal strain of ascending aorta and sinus of Valsalva in patients with chronic moderate to severe aortic regurgitation(AR)by two-dimensional speckle tracking echocardiography(2D-STE),and to reveal the impact of chronic moderate to severe AR on ascending aorta and sinus of Valsalva further.Methods: A total of 121 patients with chronic moderate to severe AR evaluated by comprehensive transthoracic echocardiography in the Second Affiliated Hospital of Dalian Medical University from September 2020 to December 2022 were consecutively collected as the case group,and 80 age-and sex-matched healthy volunteers in the same period were collected as the control group.Exclusion criteria for this study were: acute AR,combination of other more than mild valvular disease,severe coronary artery disease(stenosis≥50%),atrial fibrillation,connective tissue disease(e.g.Marfan syndrome),history of previous cardiac surgery,and poor image quality.General clinical parameters such as gender,age,height,weight,body surface area(BSA),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse pressure(PP)were recorded for all subjects.Echocardiographic parameters such as left ventricular end diastolic diameter(LVEDd),left ventricular end systolic diameter(LVESd),interventricular septal thickness(IVS),left ventricular posterior wall thickness(LVPW),diameter of left ventricular outflow tract(LVOTd),aortic annulus(AOAd),sinus of Valsalva(So Vd),sinotubular junction(STJd)and ascending aortic(AAd)were measured.Stroke volume index(SVI),left ventricular mass index(LVMI)and ascending aortic stiffness index βwere calculated according to the formula.Left ventricular ejection fraction(LVEF)was measured by biplane Simpsons method.The longitudinal strain of ascending aorta and sinus of Valsalva of the subjects were analyzed by applying QLAB off-line analysis software.The case group was further divided into dilated and non-dilated sinus of Valsalva groups according to whether the sinus of Valsalva was dilated(defined as dilated for men>38.0mm and for women>35.4mm)to compare the longitudinal strain of sinus of Valsalva(So V-LS);was further divided into dilated and non-dilated ascending aorta groups according to whether the ascending aorta was dilated(defined as dilated for men>36.5mm and for women>34.1 mm)to compare the longitudinal strain of ascending aorta(AA-LS);according to the number of aortic valves,they were divided into bicuspid aortic valve(BAV)and tricuspid aortic valve(TAV)group,the ascending aorta stiffness index β,AA-LS and So V-LS were compared between the two groups.Correlation of AA-LS and So V-LS with SBP,DBP,PP,AOA,So Vd,STJd,AAd,SVI and β was analyzed and tested for reproducibility.Results: Compared with the control group,both AA-LS and So V-LS were significantly reduced in patients with chronic moderate to severe AR(16.59±2.46 vs.24.03±2.58;19.04±2.13 vs.25.74±3.99,P<0.001 respectively).In the case group,So V-LS was lower in the dilated sinus of Valsalva group than in the non-dilated group(15.73±2.11 vs.18.32±2.19,P<0.001);compared with the non-dilated ascending aorta group,the stiffness index β was higher(9.17±1.80 vs.7.09±1.61,P<0.001)and the AA-LS was lower(18.41±1.88 vs.20.49±1.96,P<0.001)of the dilated ascending aorta group;the stiffness index β was higher in the BAV group than that in the TAV group(9.90±1.89 vs.8.25±1.89,P<0.001),and the AA-LS was lower than that in the TAV group(17.64±1.77 vs.19.3 ± 2.06,P<0.001).In addition,AA-LS was significantly negatively correlated with SBP,PP,AAd,SVI,and β(all P<0.001),So V-LS was significantly negatively correlated with SBP,PP,AOAd,So Vd,STJd and SVI(all P<0.001).Both AA-LS and So V-LS have good reproducibility within and between observers.Conclusion: 2D-STE has good repeatability in evaluating the longitudinal strain of ascending aorta and sinus of Valsalva in patients with chronic AR.The AA-LS and So V-LS decreased and the stiffness index increased in patients with chronic moderate to severe AR.The longitudinal mechanical characteristics of ascending aorta and sinus of Valsalva progressively deteriorated with the dilation of the ascending aorta and sinus of Valsalva.In addition,BAV accelerated degeneration and sclerosis of the ascending aorta.