Impaired rate of left ventricular filling in idiopathic hypertrophic subaortic stenosis and valvular aortic stenosis

In order to determine whether there is any interference with left atrial emptying or left ventricular filling in idiopathic hypertrophic subaortic stenosis (IHSS) and aortic stenosis, the fall in pressure (y descent) of the left atrial v wave following the opening of the mitral valve was analyzed in 27 patients with IHSS and in 22 patients with valvular aortic stenosis, and the results were compared to those for 13 normal subjects and 24 patients with mitral stenosis. The y descent in 0.1 sec and the mean rate of the y descent, as well as the maximum rate of decline, were reduced in all three groups of patients, as compared to those of the normal group. The changes in IHSS were more marked than those occurring in patients with aortic stenosis or mitral stenosis. These findings in patients with IHSS and valvular aortic stenosis appear to result from reduced left ventricular compliance. It is concluded that there is an impairment of left ventricular filling in IHSS and that obstruction to ventricular inflow, as well as to outflow, contributes to the hemodynamic changes in this condition.