Park Sohee, Lee Seung-Ah, Lee Jong Eun, Kang Joon-Won, Yang Dong Hyun, Koo Hyun Jung
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Korean J Radiol. 2025 Jul;26(7):626-637. doi: 10.3348/kjr.2024.1261.
This study aimed to evaluate changes in left ventricular and left atrial mechanics in relation to the severity of aortic stenosis (AS) by comparing computed tomography (CT)-derived strain values in patients with mild-to-severe AS.
This single-center retrospective study included 120 patients (median age, 76 years; 45.0% male), comprising 30, 30, and 60 patients with mild, moderate, and severe AS, respectively, all of whom underwent multiphase cardiac CT between 2015 and 2021. Patients were selected from 177 individuals who met the initial eligibility criteria, with matching for age, sex, and hypertension in a 1:1:2 ratio across the mild, moderate, and severe AS groups. Electrocardiography-gated cardiac CT images were analyzed to obtain various quantitative left ventricle (LV) and left atrium (LA) strain parameters. Statistical differences in cardiac CT-derived LV and LA strain parameters among mild, moderate, and severe AS were evaluated using the Kruskal-Wallis test, followed by post-hoc tests.
The median LV global longitudinal strain differed significantly across AS severity (GLS: -19.4%, -18.2%, and -16.2% for mild, moderate, and severe AS, respectively; < 0.001), with the absolute value decreasing as AS severity increased. Additionally, the median values of LV global circumferential strain (GCS: -29.8%, -30.8%, and -27.4%, respectively; = 0.045), LV global radial strain (GRS: 50.1%, 50.3%, and 39.3%, respectively; = 0.004), and LA conduit strain (11.5%, 11.2%, and 9.0%, respectively; = 0.031) differed significantly according to AS severity, with lower absolute values observed in patients with severe AS.
In patients with AS, CT-derived LV and LA strains revealed changes in myocardial deformation according to AS severity. Specifically, there was a gradual decrease in the absolute value of LV GLS with increasing AS severity and initial preservation until moderate AS, followed by an eventual decrease in the absolute values of LV GCS, LV GRS, and LA conduit strain in severe AS.
本研究旨在通过比较轻至重度主动脉瓣狭窄（AS）患者的计算机断层扫描（CT）衍生应变值，评估左心室和左心房力学变化与AS严重程度的关系。
这项单中心回顾性研究纳入了120例患者（中位年龄76岁；45.0%为男性），分别包括30例、30例和60例轻度、中度和重度AS患者，所有患者均在2015年至2021年间接受了多期心脏CT检查。患者从177名符合初始纳入标准的个体中选取，在轻度、中度和重度AS组中按1:1:2的比例匹配年龄、性别和高血压情况。对心电图门控心脏CT图像进行分析，以获得各种定量左心室（LV）和左心房（LA）应变参数。使用Kruskal-Wallis检验评估轻度、中度和重度AS患者心脏CT衍生的LV和LA应变参数的统计学差异，随后进行事后检验。
不同AS严重程度的LV整体纵向应变中位数差异显著（轻度、中度和重度AS的GLS分别为-19.4%、-18.2%和-16.2%；<0.001），绝对值随AS严重程度增加而降低。此外，LV整体周向应变（GCS：分别为-29.8%,-30.8%和-27.4%；=0.045）、LV整体径向应变（GRS：分别为50.1%、50.3%和39.3%；=0.004）和LA管道应变（分别为11.5%、11.2%和9.0%；=0.031）的中位数根据AS严重程度有显著差异，重度AS患者的绝对值较低。
在AS患者中，CT衍生的LV和LA应变显示出根据AS严重程度的心肌变形变化。具体而言，随着AS严重程度增加，LV GLS绝对值逐渐降低，在中度AS之前初始保持，随后在重度AS中LV GCS、LV GRS和LA管道应变绝对值最终降低。
