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KMID : 0390620160240040303
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Journal of Cardiovascular Ultrasound
2016 Volume.24 No. 4 p.303 ~ p.311
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Echocardiographic and Histologic Correlations in Patients with Severe Aortic Stenosis: Influence of Overweight and Obesity
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Avila-Vanzzini Nydia
Fritche-Salazar Juan Francisco
Vazquez-Castro Nelva Marina
Rivera-Lara Pedro
Perez-Mendez Oscar
Martinez-Herrera Humberto
Gomez-Sanchez Mario
Aranda-Frausto Alberto
Herrera-Bello Hector
Luna-Luna Maria
Godinez Jose Antonio Arias
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Abstract
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Background: Severe aortic stenosis (AS), leads to pathological left ventricular remodeling that may worsen with concomitant overweight and obesity (OW/O).
Methods: We aimed to prospectively analyze the impact of OW/O on ventricular remodeling in severe AS, by evaluating the percentage of intraendomyocardial fibrosis (PIEF) and the percentage of infiltrating intraendocardial lipid vacuoles (PIELV) and its relationship to global longitudinal strain (GLS) in patients with OW/O.
Results: 44 patients with severe AS were included, 13 non-obese (29%) and 31 OW/O (71%), all of them with left ventricular ejection fraction ≥ 55%. GLS was evaluated with 2D speckle tracking. During valve replacement, an endocardial biopsy was obtained, where PIEF and PIELV were analyzed. Patients with higher PIEF and PIELV had greater body mass index (p < 0.0001) and worse GLS (p < 0.0053). A GLS cut-off point < -14% had a sensitivity of 75%, and a specificity of 92.8% to detect important PIEF (AUC: 0.928, 95% confidence interval: 0.798?1.00). On multivariate analysis, OW/O and PIELV were independently associated to the PIEF, and OW/O and PIEF were independently associated to GLS. A high correlation between the amount of PIELV and PIEF were found.
Conclusion: Patients with severe AS and OW/O have greater PIEF and PIELV, suggesting more pathological remodeling. GLS is useful to detect subclinical myocardial injury and is potentially useful for endomyocardial fibrosis detection. The presence of higher PIELF may be a trigger factor for the development of intraendomyocardial fibrosis.
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KEYWORD
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Severe aortic stenosis , Overweight and obesity , Intraendomyocardial fibrosis , Global longitudinal strain
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