# Aortic Valve Annular Parameters in Idiopathic Hypereosinophilic Syndrome—A Detailed Investigation from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study

## TL;DR

This study investigates aortic valve annular changes in patients with hypereosinophilic syndrome and finds altered area distribution and reduced systolic function compared to healthy controls.

## Contribution

The study is the first to investigate aortic valve annular parameters in hypereosinophilic syndrome using 3D speckle-tracking echocardiography.

## Key findings

- HES patients showed a greater end-diastolic AVA area compared to controls.
- AAPSE and LV longitudinal strain were significantly reduced in HES patients.
- No absolute AVA dilation was observed in HES patients.

## Abstract

Introduction: Hypereosinophilic syndrome (HES) is characterized by a sustained elevation in eosinophil counts in the blood and subsequent eosinophil-mediated tissue or organ damage. While the aortic valve is recognized as a pivotal determinant of central hemodynamics, aortic valve annular (AVA) involvement in a series of HES patients has not yet been investigated. Therefore, this investigation aimed to determine potential abnormalities in the AVA dimensions and dynamics in patients with HES and to assess their associations with function of the left ventricle (LV). Methods: The present retrospective study initially consisted of 17 HES patients; however, one subject was excluded because of the suboptimal image quality. The final group of HES patients comprised 16 cases (mean age: 59.7 ± 12.6 years; 11 males). A group of 21 gender- and age-matched healthy subjects served as the controls (mean age: 54.0 ± 4.9 years; 12 males). Results: Among the 16 HES patients, the end-systolic AVA area was greater than, equal to, or smaller than the end-diastolic AVA area in four (25%), three (19%) and nine (56%) cases, respectively. In the matched control group, these proportions proved to be 12 (57%), one (5%) and eight (38%), respectively. No significant differences were found in the end-systolic and end-diastolic AVA minimum and maximum perimeters, areas or diameters between the HES patients and the matched controls, suggesting that no absolute AVA dilation was observed, despite an altered end-diastolic—end-systolic AVA area distribution. The AVA plane systolic excursion (AAPSE) was significantly decreased in the HES patients (0.91 ± 0.29 cm vs. 1.12 ± 0.24 cm, p = 0.05). Among the basal LV strain parameters, only the LV longitudinal strain (LS) was significantly impaired in the HES patients (−16.63 ± 4.99% vs. −21.62 ± 4.76%, p < 0.05). Conclusions: In HES patients, the AVA is not significantly dilated. However, a greater end-diastolic AVA area is found to be more frequently present compared with age- and gender-matched healthy controls. In addition, AAPSE and basal LV-LS are significantly reduced in HES patients.