Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement: Multicenter study with a brief review of the literature

Azhar Supariwala; Monica Sanchez-Ross; Valentin Suma; Karthik Seetharam; Daniel Marrero; Daniel Swistel; Sandhya Balaram; Farooq A. Chaudhry

doi:10.1111/echo.13839

Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement: Multicenter study with a brief review of the literature

Azhar Supariwala, Monica Sanchez-Ross, Valentin Suma, Karthik Seetharam, Daniel Marrero, Daniel Swistel, Sandhya Balaram, Farooq A. Chaudhry

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Midwall fibrosis and low stroke volume are independent predictors of mortality in severe aortic stenosis (AS) with preserved LV ejection fraction (LVEF). The role of speckle tracking echocardiography (STE) to identify latent myopathy pre- and post- aortic valve replacement (AVR) in high risk AS patients with normal LVEF is limited. Methods: Demographic, 2D echocardiographic, and STE data were analyzed in patients with severe AS and preserved LVEF who underwent tissue AVR. Velocity vector imaging (VVI) was used to assess regional and global peak systolic longitudinal strain (GLS). Low flow (LF) was defined as an indexed LV stroke volume <35 mL/m². Results: Between December 2008 and May 2011, 37 patients (75 ± 9 years, 51% male) had both pre- and post-AVR echos within 6.6 ± 6.5 months (median = 4 months; range = 2.5–9.5) of surgery. Compared with pre-AVR, GLS (−6.9 ± 4.9% vs −11.1 ± 4.1%; P <.001) and strain rate (−0.72 ± 0.3s^-1 vs −0.87 ± 0.3s^-1; P =.01) improved post-AVR. Pre-AVR mid-segments showed a similar myopathy as the basal segments (−9.5 ± 4.3% vs −9.0 ± 4.2%;P =.3). The 16 (43%) LF patients in this study had lower pre- and post-AVR strain compared to NF patients (GLS Pre-AVR:LF vs NF: −5.1 ± 4.1% vs −8.4 ± 4.9% (P =.04) and GLS Post-AVR:LF vs NF: −9.2 ± 3.7% vs −12.5 ± 3.9% (P =.01)). However, there was no difference in absolute and %change improvement in GLS post-AVR (LF vs NF:∆ −4.2 ± 3.5% vs ∆−4.1 ± 5.3% (P =.90) and 193 ± 214% vs 143 ± 230% change (P =.5)). The lowest GLS was seen in LF/HG AS followed by LF/LG, NF/LG and NF/HG AS; P =.03. Conclusions: Latent myopathy is more pronounced in LF AS both pre- and post-AVR. Our study provides evidence of improvement in myopathy in LF AS despite a persistent worse myopathy compared to NF patients post-AVR.

Original language	English
Pages (from-to)	611-620
Number of pages	10
Journal	Echocardiography
Volume	35
Issue number	5
DOIs	https://doi.org/10.1111/echo.13839
State	Published - May 2018
Externally published	Yes

Keywords

aortic stenosis
aortic valve replacement
longitudinal strain
myopathy
ventricular function

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10.1111/echo.13839

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Supariwala, A., Sanchez-Ross, M., Suma, V., Seetharam, K., Marrero, D., Swistel, D., Balaram, S., & Chaudhry, F. A. (2018). Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement: Multicenter study with a brief review of the literature. Echocardiography, 35(5), 611-620. https://doi.org/10.1111/echo.13839

Supariwala, Azhar ; Sanchez-Ross, Monica ; Suma, Valentin et al. / Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement : Multicenter study with a brief review of the literature. In: Echocardiography. 2018 ; Vol. 35, No. 5. pp. 611-620.

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title = "Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement: Multicenter study with a brief review of the literature",

abstract = "Background: Midwall fibrosis and low stroke volume are independent predictors of mortality in severe aortic stenosis (AS) with preserved LV ejection fraction (LVEF). The role of speckle tracking echocardiography (STE) to identify latent myopathy pre- and post- aortic valve replacement (AVR) in high risk AS patients with normal LVEF is limited. Methods: Demographic, 2D echocardiographic, and STE data were analyzed in patients with severe AS and preserved LVEF who underwent tissue AVR. Velocity vector imaging (VVI) was used to assess regional and global peak systolic longitudinal strain (GLS). Low flow (LF) was defined as an indexed LV stroke volume <35 mL/m2. Results: Between December 2008 and May 2011, 37 patients (75 ± 9 years, 51% male) had both pre- and post-AVR echos within 6.6 ± 6.5 months (median = 4 months; range = 2.5–9.5) of surgery. Compared with pre-AVR, GLS (−6.9 ± 4.9% vs −11.1 ± 4.1%; P <.001) and strain rate (−0.72 ± 0.3s-1 vs −0.87 ± 0.3s-1; P =.01) improved post-AVR. Pre-AVR mid-segments showed a similar myopathy as the basal segments (−9.5 ± 4.3% vs −9.0 ± 4.2%;P =.3). The 16 (43%) LF patients in this study had lower pre- and post-AVR strain compared to NF patients (GLS Pre-AVR:LF vs NF: −5.1 ± 4.1% vs −8.4 ± 4.9% (P =.04) and GLS Post-AVR:LF vs NF: −9.2 ± 3.7% vs −12.5 ± 3.9% (P =.01)). However, there was no difference in absolute and %change improvement in GLS post-AVR (LF vs NF:∆ −4.2 ± 3.5% vs ∆−4.1 ± 5.3% (P =.90) and 193 ± 214% vs 143 ± 230% change (P =.5)). The lowest GLS was seen in LF/HG AS followed by LF/LG, NF/LG and NF/HG AS; P =.03. Conclusions: Latent myopathy is more pronounced in LF AS both pre- and post-AVR. Our study provides evidence of improvement in myopathy in LF AS despite a persistent worse myopathy compared to NF patients post-AVR.",

keywords = "aortic stenosis, aortic valve replacement, longitudinal strain, myopathy, ventricular function",

author = "Azhar Supariwala and Monica Sanchez-Ross and Valentin Suma and Karthik Seetharam and Daniel Marrero and Daniel Swistel and Sandhya Balaram and Chaudhry, {Farooq A.}",

note = "Publisher Copyright: {\textcopyright} 2018, Wiley Periodicals, Inc.",

year = "2018",

month = may,

doi = "10.1111/echo.13839",

language = "English",

volume = "35",

pages = "611--620",

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Supariwala, A, Sanchez-Ross, M, Suma, V, Seetharam, K, Marrero, D, Swistel, D, Balaram, S & Chaudhry, FA 2018, 'Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement: Multicenter study with a brief review of the literature', Echocardiography, vol. 35, no. 5, pp. 611-620. https://doi.org/10.1111/echo.13839

Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement: Multicenter study with a brief review of the literature. / Supariwala, Azhar; Sanchez-Ross, Monica; Suma, Valentin et al.
In: Echocardiography, Vol. 35, No. 5, 05.2018, p. 611-620.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement

T2 - Multicenter study with a brief review of the literature

AU - Supariwala, Azhar

AU - Sanchez-Ross, Monica

AU - Suma, Valentin

AU - Seetharam, Karthik

AU - Marrero, Daniel

AU - Swistel, Daniel

AU - Balaram, Sandhya

AU - Chaudhry, Farooq A.

PY - 2018/5

Y1 - 2018/5

N2 - Background: Midwall fibrosis and low stroke volume are independent predictors of mortality in severe aortic stenosis (AS) with preserved LV ejection fraction (LVEF). The role of speckle tracking echocardiography (STE) to identify latent myopathy pre- and post- aortic valve replacement (AVR) in high risk AS patients with normal LVEF is limited. Methods: Demographic, 2D echocardiographic, and STE data were analyzed in patients with severe AS and preserved LVEF who underwent tissue AVR. Velocity vector imaging (VVI) was used to assess regional and global peak systolic longitudinal strain (GLS). Low flow (LF) was defined as an indexed LV stroke volume <35 mL/m2. Results: Between December 2008 and May 2011, 37 patients (75 ± 9 years, 51% male) had both pre- and post-AVR echos within 6.6 ± 6.5 months (median = 4 months; range = 2.5–9.5) of surgery. Compared with pre-AVR, GLS (−6.9 ± 4.9% vs −11.1 ± 4.1%; P <.001) and strain rate (−0.72 ± 0.3s-1 vs −0.87 ± 0.3s-1; P =.01) improved post-AVR. Pre-AVR mid-segments showed a similar myopathy as the basal segments (−9.5 ± 4.3% vs −9.0 ± 4.2%;P =.3). The 16 (43%) LF patients in this study had lower pre- and post-AVR strain compared to NF patients (GLS Pre-AVR:LF vs NF: −5.1 ± 4.1% vs −8.4 ± 4.9% (P =.04) and GLS Post-AVR:LF vs NF: −9.2 ± 3.7% vs −12.5 ± 3.9% (P =.01)). However, there was no difference in absolute and %change improvement in GLS post-AVR (LF vs NF:∆ −4.2 ± 3.5% vs ∆−4.1 ± 5.3% (P =.90) and 193 ± 214% vs 143 ± 230% change (P =.5)). The lowest GLS was seen in LF/HG AS followed by LF/LG, NF/LG and NF/HG AS; P =.03. Conclusions: Latent myopathy is more pronounced in LF AS both pre- and post-AVR. Our study provides evidence of improvement in myopathy in LF AS despite a persistent worse myopathy compared to NF patients post-AVR.

AB - Background: Midwall fibrosis and low stroke volume are independent predictors of mortality in severe aortic stenosis (AS) with preserved LV ejection fraction (LVEF). The role of speckle tracking echocardiography (STE) to identify latent myopathy pre- and post- aortic valve replacement (AVR) in high risk AS patients with normal LVEF is limited. Methods: Demographic, 2D echocardiographic, and STE data were analyzed in patients with severe AS and preserved LVEF who underwent tissue AVR. Velocity vector imaging (VVI) was used to assess regional and global peak systolic longitudinal strain (GLS). Low flow (LF) was defined as an indexed LV stroke volume <35 mL/m2. Results: Between December 2008 and May 2011, 37 patients (75 ± 9 years, 51% male) had both pre- and post-AVR echos within 6.6 ± 6.5 months (median = 4 months; range = 2.5–9.5) of surgery. Compared with pre-AVR, GLS (−6.9 ± 4.9% vs −11.1 ± 4.1%; P <.001) and strain rate (−0.72 ± 0.3s-1 vs −0.87 ± 0.3s-1; P =.01) improved post-AVR. Pre-AVR mid-segments showed a similar myopathy as the basal segments (−9.5 ± 4.3% vs −9.0 ± 4.2%;P =.3). The 16 (43%) LF patients in this study had lower pre- and post-AVR strain compared to NF patients (GLS Pre-AVR:LF vs NF: −5.1 ± 4.1% vs −8.4 ± 4.9% (P =.04) and GLS Post-AVR:LF vs NF: −9.2 ± 3.7% vs −12.5 ± 3.9% (P =.01)). However, there was no difference in absolute and %change improvement in GLS post-AVR (LF vs NF:∆ −4.2 ± 3.5% vs ∆−4.1 ± 5.3% (P =.90) and 193 ± 214% vs 143 ± 230% change (P =.5)). The lowest GLS was seen in LF/HG AS followed by LF/LG, NF/LG and NF/HG AS; P =.03. Conclusions: Latent myopathy is more pronounced in LF AS both pre- and post-AVR. Our study provides evidence of improvement in myopathy in LF AS despite a persistent worse myopathy compared to NF patients post-AVR.

KW - aortic stenosis

KW - aortic valve replacement

KW - longitudinal strain

KW - myopathy

KW - ventricular function

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Supariwala A, Sanchez-Ross M, Suma V, Seetharam K, Marrero D, Swistel D et al. Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement: Multicenter study with a brief review of the literature. Echocardiography. 2018 May;35(5):611-620. doi: 10.1111/echo.13839