Feasibility of two-dimensional speckle-tracking echocardiography of aortic valve in patients with calcific aortic valve disease

Calcific aortic valve (AV) disease is associated with increased stiffness and reduced motion of AV leaflets, has a progressive course, and can develop into aortic stenosis (AS). Our aim was to evaluate whether twodimensional speckle-tracking echocardiography (STE) may be used for the assessment of AV stiffness. We applied STE to AV leaflets in patients with various degrees of degenerative changes of AV and measured strain as an absolute value of the radial deformation of AV leaflets. Deformation of AV expressed as averaged AV strain was greatest in patients with a normal AV (23.4 +/- 6.4%), compared to those with aortic sclerosis (12.9 +/- 3.2%), moderate-to-severe AS (11.9 +/- 4%), and severe AS (10.9 +/- 3.5%) (p < 0.01). A non-linear relationship and moderate correlation of AV strain with transvalvular hemodynamic parameters was observed. In patients with mild-to-moderate AS, the strain of AV leaflets also correlated negatively with AV calcification (r =-0.59, p = 0.008). Good inter-observer agreement was obtained for averaged AV strain with a coefficient of variation of 0.15 and an interclass correlation coefficient of 0.94 (p < 0.0001). In this study we demonstrated that deformation of AV leaflets as assessed by STE might be a potential method for a non-invasive evaluation of AV biomechanical properties and of the progression of calcific aortic disease. Further development of the two-dimensional speckle tracking technique specifically for valve structures is needed to enable a better quantification of leaflet deformation. (c) 2021 Elsevier Ltd. All rights reserved.

Automated summary

Calcific aortic valve disease is associated with increased stiffness and reduced motion of AV leaflets, which may progress into aortic stenosis. This study demonstrated that two-dimensional speckle-tracking echocardiography could potentially be used for non-invasive evaluation of AV biomechanical properties. Deformation of AV leaflets measured through STE showed significant differences among patients with different degrees of AV disease and correlated with transvalvular hemodynamic parameters and AV calcification.