Aims Despite normal LVEF, significant myocyte dysfunction is present in severe aortic valve disease. We sought to investigate LV longitudinal strains (LS) before and after AVR and their relation to hemodynamic and LV geometric variables, comparing patients with AS to AR. Methods In 65 severe AS(n=46) or AR(n=19) patients without significant coronary artery disease scheduled for AVR, serial echocardiographic studies were performed before(6 days) and after surgery(5 days and 9 months). The control group included 15 age, sex-matched healthy individuals. Global and regional LS were obtained quantitatively by 2D speckle tracking method. Results Compared with control group, regional LS of base and mid-LV wall were severely depressed and global LS was also decreased in AS group. However, they were preserved in AR group. (base: -13.1±4.6 vs -16.4±3.9 vs -18.5±1.9, p<0.001/ mid : -15.3±4.7 vs -18.0±3.8 vs -19.2±1.6, p=0.003, AS vs AR vs control). Nine months after AVR, they maintained still low, irrespective of favorable regression of LVH and normal LVEF in both AS and AR.(Figure) Conclusions Subclinical myocardial dysfunction is prominent in pressure-overloaded rather than volume-overloaded condition and last more than 9 month after AVR, irrespective of hemodynamic improvement. The analysis of LV longitudinal strain might enable us to understand subtle changes in myocardial function before and after AVR in severe AV disease.Key word: Aortic valve stenosis; Aortic valve insufficiency; Ventricular function
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