الفهرس 
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Abstract
In general, the chronic aortic regurgitation (AR) is well tolerated and usually asymptomatic until severe decompensation occurs.
Preclinical alterations of LV systolic function have been demonstrated in AR patients with normal EF .Hence, early detection of such preclinical LV changes represents a clinical finding that would justify aggressive treatment aiming at reducing cardiovascular risk. However, conventional echocardiography detects abnormalities in LV systolic function only in the advanced stages of AR, when irreversible LV failure is evident.
TDI is a new technique that enables assessment of regional myocardial deformation by assessment of strain and strain rate. In contrast to TDI, 2D STE is an angle-independent technique that may allow an accurate assessment of segmental myocardial deformation.
This study was designed to evaluate LV systolic and diastolic functions in AR patients using 2D STE based longitudinal strain and strain rate imaging .
70 individuals were enrolled, divided into two groups; group I (Control group): included 20 normotensive healthy ages and sex matched volunteers free from cardiovascular risk factors. Group II: included 50 AR patients .
Participants in the study were subjected to full history taking, thorough clinical examination, 12 leads ECG.
2D echocardiography, M-mode and Doppler examination were performed; LV dimensions were measured including LVEDD, LVESD, IVSD, LVPWD, LVMI and left ventricular ejection fraction. Pulsed-wave Doppler echocardiography was performed for measuring mitral inflow velocities. Mitral annular TDI was performed in the septal and lateral mitral annuli. Strain and strain rate values were measured by 2D STE.
Results of the current study showed that:
Regarding conventional echocardiographic parameters: LVMI in AR patients (group II) highly significantly exceeded that of controls. However.
Regarding the left ventricular systolic function as assessed by strain and strain rate and LV ejection fraction:
No significant differences between the two studied groups regarding LV ejection fraction .The study showed subtle or subclinical impairment of LV systolic function in AR group as evidenced by highly significant reduction of LV systolic longitudinal strain in AR patients.
Also, there was significant reduction of systolic strain rate values in AR patients compared with controls which confirms subtle impairment of LV systolic function.
It was noted that, the systolic impairment in AR patients detected by strain and strain rate occur earlier than impairment of ejection fraction that results from changes in stroke volume and systolic pump performance.
Regarding the left ventricular diastolic function as measured by strain rate and pulsed wave Doppler and TDI:
The findings of this study indicated that significant LV diastolic impairment was common in AR groups compared with control group, as shown by inversion of E/A ratio, and changes in TDI derived indices namely Em peak velocity and E/Em ratio.
The results of this study signified that peak strain rate in early diastole (at peak E) was significantly reduced in AR group.