Subclinical right ventricular systolic dysfunction and left ventricular myocardial performance in patients with severe aortic stenosis: а prospective single-center non-randomized study

Background: The number of patients with aortic stenosis (AS) is increasing with the aging population. According to current guidelines, surgical treatment is recommended for severe AS in patients with symptoms of heart failure, a reduced ejection fraction (EF), and global left ventricular (LV) Strain. LVEF does not always reflect its contractility. Assessing right ventricular (RV) function is also important, as its dysfunction may persist even after aortic valve surgery. Objective: The study was aimed to assess RV global strain, strain of RV free wall and LV myocardial performance in patients with severe AS. Methods: This prospective non-randomized study included 72 patients with degenerative aortic valve disease and an effective orifice area of less than 1.0 cm2. The complex of examination methods included echocardiography and Speckle Tracking Imaging-2D Strain technology for assessing LV and RV deformation, LV myocardial function, 3D visualization of RV with subsequent construction of a 3D RV model and calculation of EF, fractional area change, linear dimensions, and tricuspid annulus displacement amplitude. Results: Decreased LV myocardial function was detected in 24 patients (33.3 %). Subclinical RV systolic dysfunction, namely decreased RV global strain, was detected in 40 (55.6 %) patients, while decreased RV free wall strain was observed in 11 (15.3 %) patients. Interplay was revealed between subclinical RV systolic dysfunction and LV myocardial performance in patients with severe AS. Conclusion: Subclinical LV and RV dysfunctions are observed in a significant number of patients with severe AS. Analysis and use of these data will enable to change the approach to the AS classification and the timing of surgical treatment in the future. Conclusion: Subclinical left and right ventricular dysfunction is observed in a significant number of patients with severe aortic stenosis based on echocardiography. Analysis and use of these data will likely lead to changes in the classification of AS and the timing of surgical treatment.