Relative Contribution of Afterload and Interstitial Fibrosis to Myocardial Function in Severe Aortic Stenosis
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Author + information
- Alisson Slimani, MDa,c,
- Julie Melchior, MDa,c,
- Christophe de Meester, PhDa,c,
- Sophie Pierard, MD, PhDa,c,
- Clotilde Roy, MDa,c,
- Mihaela Amzulescu, MD, PhDa,c,
- Caroline Bouzin, PhDb,
- Frédéric Maes, MDa,c,
- Agnès Pasquet, MD, PhDa,c,
- Anne-Catherine Pouleur, MD, PhDa,c,
- David Vancraeynest, MD, PhDa,c,
- Bernhard Gerber, MD, PhDa,c,
- Gebrine El Khoury, MDa,d and
- Jean-Louis Vanoverschelde, MD, PhDa,c,∗ (jean-louis.vanoverschelde{at}uclouvain.be)
- aPôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- bIREC Imaging Platform, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- cDivision of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- dDivision of Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- ↵∗Address for correspondence:
Dr. Jean-Louis Vanoverschelde, Division of Cardiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10-2881, B-1200 Brussels, Belgium.
Central Illustration
Abstract
Objectives The present study aimed at investigating the respective contribution of afterload and myocardial fibrosis to pre- and post-operative left ventricular (LV) function by using stress−strain relationships.
Background Separating the effect of myocardial dysfunction and afterload on pump performance has important implications for the prognosis and management of patients with severe aortic stenosis (AS).
Methods A total of 101 patients with isolated severe AS (57% men; mean age 71 years) and 75 healthy control subjects underwent resting 2-dimensional and speckle-tracking echocardiography to measure global circumferential strain (GCS) and global longitudinal strain (GLS), as well as end-systolic wall stress (ESWS). Normal stress−strain relationships were constructed using control subjects’ data and fitted to linear regression. End-systolic stress−strain indexes (the number of SDs from the mean regression line) were used as an afterload-independent index of myocardial function and compared with myocardial fibrosis, measured on transmural myocardial biopsies harvested at the time of surgery.
Results GCS and GLS were afterload-dependent in both control subjects and patients. The GLS-ESWS relationship of patients was shifted downward compared with control subjects. Patients with reduced pre-operative end-systolic stress−strain indexes exhibited larger degrees of interstitial myocardial fibrosis than patients without (3.8 ± 2.9% vs. 8.3 ± 6.3%, p < 0.001; and 4.9 ± 4.4% vs. 9.5 ± 6.4%; p < 0.001, for GLS and GCS, respectively). By multivariate analysis, pre-operative end-systolic stress−strain indexes were the only predictors of post-operative longitudinal and circumferential end-systolic stress−strain indexes (ß = 0.49 and ß = 0.60, respectively; p < 0.001).
Conclusions Myocardial strains are afterload-dependent. In patients with severe AS, pre-operative stress−strain indexes allow identification of patients with increased myocardial fibrosis and predict the extent of functional recovery after aortic valve replacement.
Footnotes
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 25, 2018.
- Revision received April 26, 2019.
- Accepted May 2, 2019.
- 2019 American College of Cardiology Foundation
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