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Chin JH, Kim S, Kim D, Nam JS, Kim K, Choi IC. Peak systolic myocardial velocity in patients undergoing surgical aortic valve replacement for severe aortic stenosis: prognostic value and natural course. J Clin Monit Comput 2023; 37:327-336. [PMID: 35879629 DOI: 10.1007/s10877-022-00896-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/06/2022] [Indexed: 01/24/2023]
Abstract
Myocardial systolic longitudinal function has been known to decrease in patients with severe aortic stenosis (AS). Preoperative peak systolic myocardial velocity at the septal mitral valve annulus (S'), measured using Doppler tissue imaging, was used as an indicator for myocardial systolic longitudinal function. The prognostic value and natural course of S' after surgical aortic valve replacement for severe AS have not been elucidated. This retrospective observational study included patients from January 2006 to December 2018. The patients were divided to 2 groups (pre-S'HIGH vs. pre-S'LOW) with a cut-off 5.4 cm/s of preoperative S' (pre-S') that was identified by restricted cubic spline curve. The primary outcome was postoperative long-term all-cause mortality. Nine hundred and five patients were analyzed. All-cause mortality rate at the median follow-up period of 5.2 years was 12% in pre-S'LOW and 8% in pre-S'HIGH. Multivariate analysis showed that pre-S'LOW was associated with an increased all-cause mortality (hazard ratio, 1.60; 95% confidence interval, 1.04-2.48; P = 0.032). Significantly different trajectories of postoperative S' (post-S') were found between two groups (P < 0.001 for difference): In pre-S'LOW, post-S' increased within 6 months after surgery, and gradually decreased over time, whereas it slowly decreased up to 5 years after surgery and then reached a plateau in pre-S'HIGH. The difference in pre-S' level maintained over time, and remained consistent in the adjusted analysis. Pre-S' < 5.4 cm/s was found to be associated with an increased long-term all-cause mortality. In addition, the trajectories for post-S' were different according to pre-S', which remained after adjustment.
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Affiliation(s)
- Ji-Hyun Chin
- Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcome and Research, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sehee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea
| | - Dongho Kim
- Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcome and Research, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jae-Sik Nam
- Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcome and Research, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Kyungmi Kim
- Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcome and Research, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcome and Research, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Pesce M, LaPar D, Kalfa D, Bacha E, Freud L. Peri-operative changes in diastolic function and outcomes in congenital aortic valve surgery. Echocardiography 2022; 39:178-184. [PMID: 35014728 PMCID: PMC9305218 DOI: 10.1111/echo.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/01/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
Background The ratio of early diastolic mitral inflow velocity (E) to early diastolic mitral annular tissue velocity (e’), or E/e’, is an echocardiographic measure of left ventricular filling pressure. Peri‐operative changes in E/e’ and association with outcomes have been demonstrated in adults undergoing surgery for aortic stenosis (AS). We sought to explore changes in E/e’ and other diastolic indices in the setting of congenital AS surgery and to assess for association with post‐operative outcomes among children and young adults. Methods A retrospective, single‐center study was performed among patients 6 months to 30 years of age who underwent congenital AS surgery from 2006 to 2018. Tissue Doppler indices were collected from pre‐ and post‐operative echocardiograms. Post‐operative outcomes were reviewed. Results Sixty‐six subjects with subvalvar (45%), valvar (47%), and supravalvar (8%) AS underwent surgery at a median age of 9.5 years (IQR: 4.0–14.8). Pre‐operatively, the lateral E/e’ ratio was 8.6 (6.7–11.0); 33% had E/e’≥10. Post‐operatively, the lateral e’ decreased to 9.9 cm/s (8.0–11.4), the E/e’ ratio increased to 10.4 (8.3–13.1); and 53% had E/e’≥10 (p‐values < 0.0001, 0.0072, and < 0.001, respectively). Pre‐operative lateral e’ correlated modestly with duration of intubation (ρ = −0.24, p‐value 0.048) and post‐operative lateral e’ correlated modestly with duration of intubation and length of hospital stay (ρ = −0.28 and −0.26, p‐values = 0.02 and 0.04, respectively). Conclusions Children and young adults who underwent congenital AS surgery had echocardiographic evidence of diastolic dysfunction pre‐operatively that worsened post‐operatively. Lateral e’ may be a sensitive indicator of impaired ventricular relaxation in these patients and may impact duration of intubation and hospital stay.
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Affiliation(s)
- Meredith Pesce
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork Presbyterian/Columbia University Irving Medical Center, New Haven, Connecticut, USA
| | - Damien LaPar
- Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York, New York, USA
| | - David Kalfa
- Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York, New York, USA
| | - Emile Bacha
- Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York, New York, USA
| | - Lindsay Freud
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork Presbyterian/Columbia University Irving Medical Center, New Haven, Connecticut, USA
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Determinants of left atrial volume index in patients with aortic stenosis: A multicentre pilot study. Arch Cardiovasc Dis 2017; 110:525-533. [DOI: 10.1016/j.acvd.2016.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 11/23/2022]
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Nieh CC, Teo AYH, Soo WM, Lee GK, Singh D, Poh KK. Improvement in left ventricular function assessed by tissue Doppler imaging after aortic valve replacement for severe aortic stenosis. Singapore Med J 2015; 56:672-6. [PMID: 26702162 DOI: 10.11622/smedj.2015187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The effects of reduction of left ventricular (LV) systemic afterload following aortic valve replacement (AVR) for severe aortic valve stenosis (AS) were investigated, using echocardiography and tissue Doppler imaging (TDI). METHODS We compared the preoperative and postoperative echocardiographic assessments of 23 patients with severe AS who had undergone isolated AVR (n = 13) or concomitant AVR with coronary artery bypass grafting (CABG) (n = 10). Conventional echocardiographic evaluations and TDI at the lateral mitral annulus were performed. RESULTS Echocardiography was performed at a median of 120 (interquartile range: 66-141) days after AVR. There was significant reduction in aortic transvalvular mean pressure gradient after AVR. Although LV dimensions, mass and ejection fraction remained unchanged, LV diastolic and systolic functions improved (as observed on TDI). Early diastolic (E'), late diastolic (A') and systolic (S') mitral annular velocities increased significantly (p < 0.05). There was significant improvement in TDI-derived parameters among the patients who had isolated AVR, while among the patients who had concomitant AVR with CABG, only S' had significant improvement (p = 0.028). CONCLUSION TDI was able to detect improvements in LV systolic and diastolic function after AVR for severe AS. There was less improvement in the TDI-derived diastolic parameters among patients who underwent concomitant AVR with CABG than among patients who underwent isolated AVR.
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Affiliation(s)
- Chih-Chiang Nieh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Alvin Yeng-Hok Teo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Wern Miin Soo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Glenn K Lee
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Devinder Singh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore ; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Ayhan H, Durmaz T, Keleş T, Sari C, Aslan AN, Kasapkara HA, Bozkurt E. Improvement of right ventricular function with transcatheter aortic valve implantation. SCAND CARDIOVASC J 2014; 48:184-8. [DOI: 10.3109/14017431.2014.891045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ventricular mechanics in patients with aortic valve disease: longitudinal, radial, and circumferential components. Cardiol Young 2014; 24:105-12. [PMID: 23388108 DOI: 10.1017/s1047951112002326] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Reduced long-axis shortening despite enhanced global function has been reported in aortic stenosis. We sought to improve the understanding of this phenomenon using multi-dimensional strain analysis in conjunction with the evaluation of left ventricular rotation and twist - ventricular torsion - using tissue Doppler techniques. METHODS A total of 57 patients with variable severity of aortic stenosis, aortic regurgitation, or mixed aortic valve disease, subdivided into six groups, were studied. Ventricular morphology was assessed using long-axis/short-axis and mass/volume ratios, afterload using end-systolic meridional wall stress, and global performance using ejection fraction. The circumferential and longitudinal strain was measured from two-dimensional images, and left ventricular rotation and twist were estimated as the difference in rotation between the base and apex of the ventricle. RESULTS Aortic stenosis was associated with higher mass/volume, ejection fraction, circumferential strain and left ventricular rotation and twist, significantly lower end-systolic wall stress, and a trend towards lower longitudinal strain compared with normal. Myocardial mechanics in aortic regurgitation were normal despite ventricular dilation. Mixed aortic valve disease showed findings similar to aortic stenosis. Left ventricular rotation and twist correlated with midwall circumferential strain (r = 0.62 and p < 0.0001), endocardial circumferential strain (r = 0.61 and p < 0.0001), and end-systolic wall stress (r = 0.48 and p < 0.0001), but not with longitudinal strain (r = 0.18 and p > 0.05). CONCLUSIONS Myocardial mechanics are normal in patients with aortic regurgitation, independent of abnormalities in cardiac geometry. Conversely, in aortic stenosis and mixed aortic valve disease, significant alterations in the patterns of fibre shortening are found. The effects of stenosis on cardiac function seem to dominate the effect of ventricular remodelling.
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Dal-Bianco JP, Sengupta PP, Khandheria BK. Role of echocardiography in the diagnosis and management of asymptomatic severe aortic stenosis. Expert Rev Cardiovasc Ther 2014; 6:223-33. [DOI: 10.1586/14779072.6.2.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ozkan A. Low gradient "severe" aortic stenosis with preserved left ventricular ejection fraction. Cardiovasc Diagn Ther 2013; 2:19-27. [PMID: 24282693 DOI: 10.3978/j.issn.2223-3652.2012.01.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/04/2012] [Indexed: 11/14/2022]
Abstract
In developed nations, aortic stenosis (AS) is the most common valvular heart disease presentation, and its prevalence is increasing due to aging populations. Accurate diagnosis of the disease process and determination of its severity are essential in clinical decision-making. Although current guidelines recommend measuring transvalvular gradients, maximal velocity, and aortic valve area in determining the disease severity, inconsistent grading of disease severity remains a common problem in clinical practice. Recent studies suggest that patients with paradoxical low-flow and/or low-gradient, severe AS are at a more advanced stage of the disease process and have a poorer prognosis. This mode of presentation may lead to an undervaluation of symptoms and inappropriate delay of AVR. Therefore, this challenging clinical situation should be carefully assessed in particular in symptomatic patients and clinical decisions should be tailored individually.
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Affiliation(s)
- Alper Ozkan
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Hayabuchi Y, Sakata M, Ohnishi T, Inoue M, Kagami S. Ratio of early diastolic tricuspid inflow to tricuspid lateral annulus velocity reflects pulmonary regurgitation severity but not right ventricular diastolic function in children with repaired Tetralogy of Fallot. Pediatr Cardiol 2013; 34:1112-7. [PMID: 23247587 DOI: 10.1007/s00246-012-0612-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/06/2012] [Indexed: 02/01/2023]
Abstract
The current study assessed relationships between the ratio of early diastolic tricuspid inflow to tricuspid lateral annular velocity (tricuspid E/e') and right ventricular (RV) function in children after tetralogy of Fallot (TOF) repair. The RV function of 25 asymptomatic children with surgically repaired TOF (age 3.3 ± 2.0 years) was assessed by echocardiography and cardiac catheterization. Right ventricular end-diastolic pressure and volume (RVEDP and RVEDV), systolic pressure, and ejection fraction, as well as mean pulmonary arterial pressure, mean right atrial pressure (RAP), and the severity of both pulmonary regurgitation (PR) and tricuspid regurgitation (TR) were assessed in terms of the contribution to tricuspid E/e'. Univariate analysis discovered a relationship between tricuspid E/e' and RVEDV (R(2) = 0172), pressure half-time of PR (PR-PHT) (R(2) = 0.173), and TR grade (R(2) = 0.145) (p < 0.01 for each). After multivariate adjustment, PR-PHT was significantly associated with tricuspid E/e' (β = 0.210; p < 0.001). Tricuspid E/e' was not significantly associated with RVEDP or RAP. In conclusion, tricuspid E/e' does not indicate RV diastolic function but reflects the severity of PR in asymptomatic children after TOF repair.
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Affiliation(s)
- Yasunobu Hayabuchi
- Department of Pediatrics, University of Tokushima, Kuramoto-cho-3, Tokushima 770-8305, Japan.
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Asymmetric septal hypertrophy in patients with severe aortic stenosis: The usefulness of associated septal myectomy. J Thorac Cardiovasc Surg 2013; 145:171-5. [DOI: 10.1016/j.jtcvs.2011.10.096] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/25/2011] [Accepted: 10/31/2011] [Indexed: 11/23/2022]
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Kempny A, Diller GP, Kaleschke G, Orwat S, Funke A, Radke R, Schmidt R, Kerckhoff G, Ghezelbash F, Rukosujew A, Reinecke H, Scheld HH, Baumgartner H. Longitudinal left ventricular 2D strain is superior to ejection fraction in predicting myocardial recovery and symptomatic improvement after aortic valve implantation. Int J Cardiol 2012; 167:2239-43. [PMID: 22766243 DOI: 10.1016/j.ijcard.2012.06.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 06/07/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Predicting improvement of myocardial function after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) remains a challenge. As ejection fraction (EF) may be of limited value in detecting early myocardial dysfunction and predicting outcome, we assessed the potential of echocardiographic longitudinal function in this setting. MATERIALS AND METHODS Left ventricular (LV) function was assessed using EF, mitral annular plane systolic excursion (MAPSE), peak longitudinal 2D strain (LS) and strain rate (SR) in101consecutive patients with severe symptomatic AS (age 81 ± 11 years) undergoing TAVI. Echocardiography and assessment of clinical status including NYHA functional class were performed prior and after intervention (median 70 days). RESULTS Pre-interventional EF was 57 ± 17% and 32 patients (32%) had an EF<50% while 58 patients (57%) were found to have an impaired LS. After TAVI there was no significant change in EF. In contrast, LS, SR and MAPSE improved significantly (-14.0 ± 4.4 vs. -15.5 ± 4.0%; p=0.007, 0.68 ± 0.24 vs. 0.78 ± 0.23/s, p=0.002; and 9.1 ± 3.2 vs. 10.2 ± 3.3mm, p=0.006, respectively). Receiver Operating Curve characteristic analysis identified a pre-TAVI LS>-13.3% as the optimal cut-off value for predicting lack of LS recovery post TAVI. There was a marked improvement in NYHA FC after intervention (p=0.0002). Among the studied echocardiographic parameters LS change correlated closest with NYHA class improvement (r=0.42, p=0.0008). CONCLUSION Overall, LS appears to be more sensitive for detecting early myocardial damage in patients with AS compared to conventional echocardiographic parameters. More importantly, pre-interventional LS may identify irreversible myocardial dysfunction and LS improvement correlates with symptomatic improvement after intervention.
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Affiliation(s)
- Aleksander Kempny
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Forsberg LM, Tamás E, Vánky F, Nielsen NE, Engvall J, Nylander E. Left and right ventricular function in aortic stenosis patients 8 weeks post-transcatheter aortic valve implantation or surgical aortic valve replacement. ACTA ACUST UNITED AC 2011; 12:603-11. [PMID: 21705353 DOI: 10.1093/ejechocard/jer085] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Knowledge of longitudinal left and right ventricular (LV and RV) function after transcatheter aortic valve implantation (TAVI) is scarce. We hypothesized that the longitudinal systolic biventricular function in aortic stenosis (AS) patients is affected differently by TAVI and surgical aortic valve replacement (SAVR). METHODS AND RESULTS Thirty-three AS patients (all-TAVI group, age 81 ± 9 years, 18 female), with EuroSCORE 18 ± 9%, were accepted for TAVI. Seventeen of these patients were matched (by gender, age, and LV function) to 17 patients undergoing SAVR. Conventional echocardiographic parameters, systolic atrioventricular plane displacement (AVPD) at standard sites and peak systolic velocity (PSV) by pulsed tissue Doppler at basal RV free wall, LV lateral wall, and septum were studied before and 8 weeks after the procedure. Procedural success was 100%, and 30-day mortality 9%. In all TAVI patients, AVPD(lateral), PSV(lateral), AVPD(septal), and PSV(septal) increased (P< 0.001, 0.003, 0.006 and 0.002). When studying the matched patients postoperatively, both the SAVR and TAVI patients had increased PSV(lateral) and AVPD(lateral) (SAVR: P=0.03 and P=0.04, TAVI: P=0.04 and P=0.01). The PSV(RV) increased in the all-TAVI group (P=0.007), while the AVPD(RV) was unchanged. SAVR patients had decreased AVPD(RV) (P=0.001) and PSV(RV) (P=0.004), while the matched TAVI patients had unchanged RV function parameters. CONCLUSION An improvement in regional longitudinal LV function in the septal and lateral wall could be seen after TAVI. Among the matched patients, both the TAVI and SAVR patients seemed to improve LV function in the lateral wall. RV systolic function increased in TAVI patients, but was impaired in the matched SAVR group at the 8-week follow-up.
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Affiliation(s)
- Lena M Forsberg
- Departments of Clinical Physiology, Medical and Health Sciences, University Hospital, SE-581 85, Linköping, Sweden.
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Jassal DS, Bhagirath KM, Karlstedt E, Zeglinski M, Dumesnil JG, Teo KK, Tam JW, Chan KL. Evaluating the effectiveness of rosuvastatin in preventing the progression of diastolic dysfunction in aortic stenosis: A substudy of the aortic stenosis progression observation measuring effects of rosuvastatin (ASTRONOMER) study. Cardiovasc Ultrasound 2011; 9:5. [PMID: 21299902 PMCID: PMC3041733 DOI: 10.1186/1476-7120-9-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 02/07/2011] [Indexed: 11/10/2022] Open
Abstract
Background Tissue Doppler imaging (TDI) is a noninvasive echocardiographic method for the diagnosis of diastolic dysfunction in patients with varying degrees of aortic stenosis (AS). Little is known however, on the utility of TDI in the serial assessment of diastolic abnormalities in AS. Objective The aim of the current proposal was to examine whether treatment with rosuvastatin was successful in improving diastolic abnormalities in patients enrolled in the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin (ASTRONOMER) study. Methods Conventional Doppler indices including peak early (E) and late (A) transmitral velocities, and E/A ratio were measured from spectral Doppler. Tissue Doppler measurements including early (E') and late (A') velocities of the lateral annulus were determined, and E/E' was calculated. Results The study population included 168 patients (56 ± 13 years), whose AS severity was categorized based on peak velocity at baseline (Group I: 2.5-3.0 m/s; Group II: 3.1-3.5 m/s; Group III: 3.6-4.0 m/s). Baseline and follow-up hemodynamics, LV dimensions and diastolic functional parameters were evaluated in all three groups. There was increased diastolic dysfunction from baseline to follow-up in each of the placebo and rosuvastatin groups. In patients with increasing severity of AS in Groups I and II, the lateral E' was lower and the E/E' (as an estimate of increased left ventricular end-diastolic pressure) was higher at baseline (p < 0.05). However, treatment with rosuvastatin did not affect the progression of diastolic dysfunction from baseline to 3.5 year follow-up between patients in any of the three predefined groups. Conclusion In patients with mild to moderate asymptomatic AS, rosuvastatin did not attenuate the progression of diastolic dysfunction.
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Affiliation(s)
- Davinder S Jassal
- Cardiology Division, Department of Internal Medicine, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
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Fijalkowski M, Koprowski A, Galaska R, Gruchala M, Pawlaczyk R, Brzezinski M, Rogowski J, Rynkiewicz A. Improvement of Ultrasonic Myocardial Properties after Aortic Valve Replacement for Pure Severe Aortic Stenosis: The Predictive Value of Ultrasonic Tissue Characterization for Left Ventricle Reverse Remodeling. J Am Soc Echocardiogr 2010; 23:1060-6. [DOI: 10.1016/j.echo.2010.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Indexed: 10/19/2022]
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Saraiva RM, Matsumura Y, Yamano T, Greenberg N, Thomas JD, Shiota T. Relation of left atrial dysfunction to pulmonary artery hypertension in patients with aortic stenosis and left ventricular systolic dysfunction. Am J Cardiol 2010; 106:409-16. [PMID: 20643255 DOI: 10.1016/j.amjcard.2010.03.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 03/15/2010] [Accepted: 03/15/2010] [Indexed: 11/17/2022]
Abstract
Pulmonary artery hypertension (PAH) increases mortality in patients with severe aortic stenosis. We hypothesized that left atrial (LA) dysfunction would be related to PAH in patients with severe aortic stenosis complicated by left ventricular (LV) systolic dysfunction. The data from 70 patients with severe aortic stenosis and LV systolic dysfunction were analyzed. From the transmitral flow, the peak early (E) and late (A) diastolic velocities were obtained. From the pulmonary vein flow, the peak S-wave, D-wave, and reversed atrial wave velocities were determined. The right ventricular systolic pressure was measured in 50 patients and averaged 38 +/- 13 mm Hg. Patients with PAH (n = 19) presented with greater LV diameters, E/A ratio, E-wave velocity, LV mass index, reversed atrial wave velocity, and LA volume (p <0.05) and lower S/D ratio and total and active LA emptying fractions (p <0.05). Simple linear regression analysis revealed that the LA volumes and total and active LA emptying fractions displayed the strongest correlations with the right ventricular systolic pressure. Multiple regression analysis revealed that the minimum LA volume (r = 0.61, p = 0.0001) independently correlated with the right ventricular systolic pressure, irrespective of the aortic valve (AV) area or gradient. In patients who underwent an echocardiographic examination >or=1 month after AV replacement, LA function had improved significantly. The degree of improvement was related to the degree of recovery of the LV diastolic function and diameter. In conclusion, in patients with severe aortic stenosis and concomitant LV systolic dysfunction, the LA function parameters displayed the strongest correlations with the right ventricular systolic pressure, irrespective of the AV area or gradient and were impaired in patients with PAH. LA function recovered after AV replacement. Additional studies are warranted to determine the prognostic significance of LA function in this setting.
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Affiliation(s)
- Roberto M Saraiva
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Stewart RAH, Kerr AJ, Whalley GA, Legget ME, Zeng I, Williams MJA, Lainchbury J, Hamer A, Doughty R, Richards MA, White HD. Left ventricular systolic and diastolic function assessed by tissue Doppler imaging and outcome in asymptomatic aortic stenosis. Eur Heart J 2010; 31:2216-22. [DOI: 10.1093/eurheartj/ehq159] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Casaclang-Verzosa G, Malouf JF, Scott CG, Juracan EM, Nishimura RA, Pellikka PA. Does Left Atrial Size Predict Mortality in Asymptomatic Patients with Severe Aortic Stenosis? Echocardiography 2010; 27:105-9. [DOI: 10.1111/j.1540-8175.2009.01002.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Guarracino F, Talini E, Landoni G, Petronio S, Giannini C, Di Bello V. Effect of aortic valve surgery on left ventricular diastole assessed by echocardiography and neuroendocrine response: percutaneous versus surgical approach. J Cardiothorac Vasc Anesth 2009; 24:25-9. [PMID: 19944626 DOI: 10.1053/j.jvca.2009.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Aortic valve implantation through peripheral vascular access is an option for high-risk patients with severe aortic valve stenosis. The authors aimed to compare the acute effect of endovascular and surgical aortic valve procedures on left ventricular diastolic function. DESIGN A case-matched, nonrandomized study. SETTING A university hospital. PARTICIPANTS Patients with aortic stenosis. INTERVENTIONS B-natriuretic peptide was measured in 30 patients with a logistic EuroSCORE > or =20% undergoing endovascular aortic valve implantation. Patients were case matched (age, mitral flow propagation velocity, mitral annulus early diastolic velocity, and B-natriuretic peptide measurement) with 30 control patients undergoing surgical aortic valve replacement through sternotomy. Left ventricular diastole was evaluated initially and after valve procedures with echocardiography by mitral flow propagation velocity and mitral annulus early diastolic velocity. MEASUREMENTS AND MAIN RESULTS B-natriuretic peptide was similar preoperatively in the 2 groups (346 [188-438] v 367 [211-458] pg/mL) and higher (p = 0.006) in the surgical group postoperatively (389.5 [237-479] v 710.5 [389-822] pg/mL), with a postprocedural statistically significant increase only in the surgical group. Diastolic function was similar in the 2 groups preoperatively, improved postoperatively in the endovascular group, and worsened in the surgical group. CONCLUSIONS B-natriuretic peptide increased after surgical but not after endovascular aortic valve replacement. Furthermore, endovascular aortic valve implantation acutely improved left ventricular diastolic function as documented by increases in mitral flow propagation velocity and mitral annulus early diastolic velocity.
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Affiliation(s)
- Fabio Guarracino
- Cardiothoracic Department, Azienda Ospedaliera Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy.
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Skubas N. Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists’ Armamentarium: A Core Review. Anesth Analg 2009; 108:48-66. [DOI: 10.1213/ane.0b013e31818a6c4c] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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22
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Management of Asymptomatic Severe Aortic Stenosis. J Am Coll Cardiol 2008; 52:1279-92. [DOI: 10.1016/j.jacc.2008.07.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 06/30/2008] [Accepted: 07/01/2008] [Indexed: 11/23/2022]
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Nistri S, Galderisi M, Faggiano P, Antonini-Canterin F, Ansalone G, Dini FL, Di Salvo G, Gallina S, Mele D, Montisci R, Sciomer S, Di Bello V, Mondillo S, Marino PN. Practical echocardiography in aortic valve stenosis. J Cardiovasc Med (Hagerstown) 2008; 9:653-65. [DOI: 10.2459/jcm.0b013e3282f27d49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Use of tissue Doppler to distinguish discrete upper ventricular septal hypertrophy from obstructive hypertrophic cardiomyopathy. Am J Cardiol 2008; 101:1498-503. [PMID: 18471465 DOI: 10.1016/j.amjcard.2008.01.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 01/03/2008] [Accepted: 01/03/2008] [Indexed: 11/21/2022]
Abstract
Discrete upper septal hypertrophy (DUSH) is a well-recognized but poorly understood echocardiographic finding that may indicate localized remodeling modulated by pressure loading or a forme fruste variant of obstructive hypertrophic cardiomyopathy (HC). It was hypothesized that (1) a comparison of tissue Doppler indexes of myocardial function in normal patients and those with DUSH or aortic stenosis (AS) could provide insight into the clinical significance of DUSH and (2) these indexes could distinguish between DUSH and obstructive HC. A retrospective analysis was performed on patients aged 50 to 80 years who underwent routine echocardiography and who could be classified into normal, DUSH, AS, and HC groups (n = 25, 33, 23, and 34, respectively) on the basis of clinical and echocardiographic criteria. Early diastolic mitral annular velocities (Ea) in the DUSH (7.1 +/- 1.8 cm/s) and AS (7.1 +/- 1.7 cm/s) groups were lower compared with those in the normal group (9.3 +/- 1.9 cm/s) and higher compared with those in the HC group (5.4 +/- 1.3 cm/s), whereas the E/Ea ratio was higher in the DUSH and AS groups (10.0 +/- 3.1 and 11.3 +/- 2.8, respectively) compared with the normal group (7.1 +/- 1.6) and lower compared with the HC group (18.8 +/- 7.5). These differences remained significant after adjusting for age and the use of beta blockers and calcium channel blockers. E/Ea > or =13 distinguished between patients with HC and those with DUSH (sensitivity 78%, specificity 90%, positive predictive value 90%, negative predictive value 81%). In conclusion, abnormal Ea and E/Ea in patients with DUSH, with values similar to those in patients with AS, suggest that DUSH may represent a variant hypertrophic response to chronic pressure loading. Simple echocardiographic indexes may be helpful in distinguishing between patients with DUSH and those with obstructive HC.
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Poh KK, Chan MYY, Yang H, Yong QW, Chan YH, Ling LH. Prognostication of Valvular Aortic Stenosis Using Tissue Doppler Echocardiography: Underappreciated Importance of Late Diastolic Mitral Annular Velocity. J Am Soc Echocardiogr 2008; 21:475-81. [DOI: 10.1016/j.echo.2007.08.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Indexed: 10/22/2022]
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26
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Vitarelli A, Morichetti MC, Conde Y, Cimino E, D'Orazio S, Stellato S, Padella V, Caranci F, Battaglia D. Assessment of severity in aortic stenosis-incremental value of endocardial function parameters compared with standard indexes. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1224-35. [PMID: 17466445 DOI: 10.1016/j.ultrasmedbio.2007.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Revised: 02/01/2007] [Accepted: 02/13/2007] [Indexed: 05/15/2023]
Abstract
Several studies have reported that patients (pts) with severe aortic stenosis and similar pressure gradients or even similar aortic valve areas may have quite different symptomatic status and clinical outcomes suggesting that other factors might have a significant impact on the pathophysiology of this disease. Our purpose was to assess the severity of subendocardial wall dysfunction in symptomatic and asymptomatic pts with aortic stenosis using tissue Doppler imaging (TDI), strain rate imaging (SRI) and cyclic variation of integrated backscatter (IB). We studied 68 pts with aortic valvar stenosis and 46 subjects with no signs of heart disease. SRI/IB indexes were calculated in the apical four chambers views at endocardial level. Early diastolic endocardial strain rate showed the best correlation with transvalvar pressure gradients and valve areas. Compared with controls, symptomatic pts showed a more marked decrease in endocardial strain, strain rate and cyclic variation of IB. Receiver operating characteristic (ROC) curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the prediction of symptoms were >/=60 mm Hg for the pressure gradient, less than 0.60 cm(2)/m(2) for aortic valve area, less than 20% for strain, less than 2.0 s(-1) for strain rate and less than 3.0 dB for cyclic variation. The combination of pressure gradient, aortic valve area and SRI/IB parameters resulted in an improvement of the overall performance for predicting the symptomatic state. Thus, SRI/IB parameters have an incremental value in differentiating symptomatic and asymptomatic pts with aortic stenosis compared with conventional hemodynamic parameters.
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van der Maaten JMAA, de Vries AJ, Rietman GW, Gallandat Huet RCG, De Hert SG. Effects of Preemptive Enoximone on Left Ventricular Diastolic Function After Valve Replacement for Aortic Stenosis. J Cardiothorac Vasc Anesth 2007; 21:357-66. [PMID: 17544886 DOI: 10.1053/j.jvca.2006.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Left ventricular (LV) hypertrophy is associated with increased diastolic chamber stiffness early after aortic valve replacement for valve stenosis. Enoximone, a phosphodiesterase III inhibitor, has been shown to improve myocardial contractility and relaxation when administered as a single dose after cardiac surgery. The present study investigated, by analysis of transmitral flow velocity patterns and end-diastolic pressure-area relations, whether enoximone administered before aortic valve surgery has an effect on LV diastolic properties. DESIGN Prospective, randomized study. SETTING Referral center for cardiothoracic surgery at a university hospital. PARTICIPANTS Thirty-four patients undergoing aortic valve replacement for aortic stenosis. INTERVENTIONS Patients in the enoximone group (n = 17) received a bolus dose of 0.35 mg/kg (0.15 mg/kg before aortic cross-clamping and 0.2 mg/kg added to the cardioplegic solution). Individual pressure-area relations (pulmonary capillary wedge pressure v left ventricular end-diastolic area) were obtained by using volume loading by leg elevation before and after surgery with closed chest. MEASUREMENTS AND MAIN RESULTS The pressure-area relation on the pressure-area plot was shifted to the left after surgery, indicating decreased LV diastolic distensibility in the enoximone and control groups and providing evidence of decreased LV diastolic function. Indices of LV diastolic chamber stiffness, LV operating stiffness (K(LV)) derived from the deceleration time of early ventricular filling, and the constant of chamber stiffness (beta) derived from pressure-area relations were not different after enoximone treatment. Systolic LV function was unaltered after cardiac surgery in both groups. Analysis of changes in transmitral flow patterns identified an increased atrial filling fraction in enoximone-treated patients, suggesting increased atrial systolic function. The unaltered systolic pulmonary venous flow velocity compared with the decrease in the control group after volume loading further supports preservation of left atrial reservoir function with enoximone in the absence of evidence for decreased LV stiffness. CONCLUSION Preemptive enoximone did not change LV diastolic function based on diastolic filling patterns or LV stiffness indices (K(LV) and beta) derived from Doppler early filling deceleration time and pressure-area relations. Doppler data suggested improvement of left atrial systolic function and preservation of left atrial reservoir function with enoximone.
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Affiliation(s)
- Joost M A A van der Maaten
- Department of Anesthesiology, Section of Cardiothoracic Anesthesia, University Medical Center Groningen, Groningen, The Netherlands.
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Lee JH, Kim YH, Hyun MC, Lee SB. Evaluation of short-term cardiac function by tissue Doppler imaging in pre and postoperative period of congenital heart disease. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.5.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jun-Hwa Lee
- Department of Pediatrics, School of Medicine, Sungkyunkwan University, Masan Samsung Hospital, Masan, Korea
| | - Yeo-Hyang Kim
- Department of Pediatrics, School of Medicine, Keimyung University, Korea
| | - Myung-Chul Hyun
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang-Bum Lee
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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Hadano Y, Murata K, Tanaka N, Muro A, Akagawa E, Tanaka T, Kunichika H, Matsuzaki M. Ratio of Early Transmitral Velocity to Lateral Mitral Annular Early Diastolic Velocity Has the Best Correlation With Wedge Pressure Following Cardiac Surgery. Circ J 2007; 71:1274-8. [PMID: 17652894 DOI: 10.1253/circj.71.1274] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although previous investigators reported that mitral annular velocity predicts mean pulmonary capillary wedge pressure (PCWP), it is unknown whether the lateral or septal mitral annular velocity more faithfully predicts PCWP after cardiac surgery. METHODS AND RESULTS To assess the effect of cardiac surgery on the predictive values for PCWP by measuring mitral annular velocity, 52 consecutive patients undergoing cardiac surgery were studied. All patients underwent transthoracic echocardiography and right-sided cardiac catheterization both before and after surgery. The peak early diastolic velocity of transmitral flow (E) was measured by pulsed-wave Doppler and the peak early diastolic velocities of the lateral (LEa) and septal (SEa) mitral annulus by pulsed-wave tissue Doppler imaging. The ratios of E to LEa (E/LEa) and SEa (E/SEa) were calculated. Immediately after echocardiography, PCWP was measured using a balloon-tipped pulmonary artery catheter. After surgery, LEa was significantly increased (6.4+/-2.7 vs 8.6+/-3.3 cm/s, p<0.001), but SEa was unchanged (6.0+/-2.5 vs 5.5+/-2.3 cm/s, p=0.09). E/LEa correlated well with PCWP both before and after surgery (r=0.79 and r=0.69, respectively, p<0.001). Although E/SEa correlated well before surgery (r=0.67, p<0.001), it correlated only weakly after surgery (r=0.44, p<0.01). CONCLUSIONS E/LEa has the best correlation with PCWP both before and after cardiac surgery and may be more useful than E/SEa in the noninvasive estimation of PCWP.
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Affiliation(s)
- Yasuyuki Hadano
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, and Yamaguchi University Hospital, Ube, Japan.
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Van Pelt NC, Stewart RAH, Legget ME, Whalley GA, Wong SP, Zeng I, Oldfield M, Kerr AJ. Longitudinal left ventricular contractile dysfunction after exercise in aortic stenosis. Heart 2006; 93:732-8. [PMID: 17090563 PMCID: PMC1955170 DOI: 10.1136/hrt.2006.100164] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether longitudinal left ventricular systolic function measured by Doppler tissue imaging (DTI) after exercise can identify early left ventricular dysfunction in asymptomatic patients with moderate-severe aortic stenosis. DESIGN Case-control study. SETTING Outpatient cardiology departments. PATIENTS 20 patients with aortic stenosis, with or without equivocal symptoms, a peak aortic valve velocity > or =3 m/s, and left ventricular ejection fraction >50% and 15 aged-matched normal controls. INTERVENTIONS Echocardiogram performed at rest and immediately after treadmill exercise. MAIN OUTCOME MEASURES The peak systolic velocity of the lateral mitral annulus (S') by DTI at rest and immediately after exercise, exercise capacity, exercise systolic blood pressure and the plasma level of B-type natriuretic peptide (BNP). RESULTS For patients with aortic stenosis, mean (SD) aortic valve area was 0.95 (0.3) cm(2). At rest, S' was similar for patients with aortic stenosis and controls, respectively (8.5 (1.5) vs 9.1 (1.8) cm/s, p = 0.15). However, after exercise, S' (12.2 (3.2) vs 17 (2.8) cm/s, p<0.001) and the increase in S' between rest and exercise (4 (3) vs 7.9 (1.5) cm/s, p<0.001) were lower in patients with aortic stenosis. In patients with aortic stenosis, a smaller increase in S' after exercise was associated with lower exercise capacity (r = 0.5, p = 0.02), a smaller increase in exercise systolic blood pressure (r = 0.6, p = 0.005) and higher plasma level of BNP (r = 0.66, p = 0.002). CONCLUSION In asymptomatic patients with moderate-severe aortic stenosis a lower than normal increase in peak systolic mitral annular velocity after treadmill exercise is a marker of early left ventricular systolic dysfunction.
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Affiliation(s)
- Niels C Van Pelt
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
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