Speckle Tracking Imaging in Patients With Low Ejection Fraction Aortic Stenosis (SPArKLE-AS)
Speckle Tracking Imaging in Patients With Low Ejection Fraction Aortic Stenosis (SPArKLE-AS)
In patients with aortic stenosis and low ejection fraction, how can we predict who will
 recover their ejection fraction after aortic valve replacement? We plan to observe 50
 patients with Low EF aortic stenosis and perform serial echocardiograms pre and post-aortic
 valve replacement and analyze regional wall motion contractility with a new software
 application called speckle tracking imaging.
In patients with severe aortic stenosis and LV dysfunction, 76% of patients have an
 improvement of ventricular function and NYHA class, after aortic valve replacement. The
 prognostic indicators of which patients will recover EF post-operatively, has not been fully
 established, but has been linked to a history of prior MI and pre-operative aortic valve
 area. Furthermore it is hypothesized that those ventricles that do not recover are fibrosed,
 either from prior MI or long standing LVH (hypertrophy).

 Currently systolic and diastolic function will be measured pre-operatively with standard 2D
 echo and Doppler. 2D Strain and Strain rate imaging with speckle tracking is a novel method
 of assessing regional as well as global "contractility". This method overcomes many
 limitations inherent in assessing myocardial functioning with current methodology, mainly it
 is reproducible, objective, and is independent of myocardial translation, tethering and
 furthermore as speckle tracking is derived from B mode images is independent of Doppler
 angle.The applicability of this technology to patients with aortic valve stenosis and
 systolic dysfunction and its clinical significance has not been evaluated. We hypothesize
 that patients with reduced peak systolic strain rate and diastolic strain rates at baseline
 adjusted for LVEF will have poorer recovery of LVEF than those with relatively preserved
 strain or strain rate. As this is a pilot study, we plan to prospectively analyze 50
 consecutive patients who have severe aortic stenosis and left ventricular systolic
 dysfunction, EF under 40% with Speckle imaging derived strain rate imaging pre and
 post-operatively for aortic valve replacement. This would be done as part of routine
 pre-operative and post-operative transthoracic echocardiography using standard views, with
 the exception that all studies would need to be done on the GE Vivid 7 digital ultrasound
 system. Speckle derived imaging data is derived from standard B mode (Grey scale images),
 with a frame rate of 50 f/s. 3 D images will also be obtained. Post-operative TTE's will be
 performed before discharge and 4-12 months+/- 30 days after discharge. Baseline
 characteristics will be taken from the standard pre-operative baseline study including basic
 2 D valve area, EF, wall thickness and geometry, and Doppler flow data. Exclusion criteria:
 Patients with prior cardiac surgery including CABG or other valve replacement, more than mild
 mitral valve or aortic regurgitation and chronic kidney disease (Cr 1.5), emergent aortic
 valve replacement, or endocarditis, or CAD on LHC > 50%. Informed consent will be obtain on
 all patients, and they will only be included if they consent. No surgery will be delayed for
 purpose of the study if the proper hardware/GE VIVID system is not available.
Inclusion Criteria:

 -  Severe aortic stenosis with ejection fraction less than 40% that is schedule to
 undergo aortic valve replacement

 Exclusion Criteria:

 -  Creatinine > 2

 -  More than moderate mitral, tricuspid, or aortic regurgitation.

 -  Endocarditis

 -  Emergent surgery

 -  Prior sternotimy