We read with interest the article by Hulshof et al. (2017). In their paper the authors propose a new analysis based on a simultaneous strain–load (volume or area) calculation to better describe patients with aortic valve disease.
Our group had presented for the first time the strain–volume analysis for the description of left ventricular (LV) remodelling in 2011 (Lilli et al. 2011) (previously presented at ESC Congress 2010, Lilli et al. 2010) and we have recently validated the same method with tagging cardiac magnetic resonance (Lilli et al. 2017).
We have genuinely appreciated the study by Hulshof et al., but the method they propose is not completely novel since we have already investigated and described the strain–volume behaviour in normal subjects and in various subsets of pathological LV remodelling. We proposed two main parameters for the systolic assessment of the curves: (a) slope, that does not provide any information about position in the Cartesian axis; (b) strain to volume ratio, that highlights also the position of the curve in the Cartesian axis (i.e. distance from the origin) (very similar to strain_ES in the paper by Hulshof et al.).
In their work, the authors reported the two parameters. Interestingly, the authors provided new insights into our method of studying aortic valvular disease through the diastolic evaluation of the curve in the early and late diastole. Notably, in the authors’ work, only the parameters we had proposed were able to discriminate aortic valve stenosis from aortic valve regurgitation.
The authors had also firstly applied this method of analysis to athlete hearts (Oxborough et al. 2016) and more recently to pulmonary artery hypertension. Again, we appreciate the utilization of the method we had proposed but we felt surprised that the technique was presented as completely novel in both original articles and related editorial (Donal et al. 2017).
Additional information
Competing interests
None declared.
Edited by: Laura Bennet & Bruce Smaill
NOTE: The authors of the paper on which this letter was written have been asked whether they would like to reply. The link to the paper is: https://doi.org/10.1113/JP273526. If the Reply is submitted, it will be linked to this letter once it has been accepted.
References
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