ORIGINAL ARTICLES

Valvular heart disease

Preoperative tissue Doppler imaging differentiates beneficial from detrimental left ventricular hypertrophy in patients with surgical aortic stenosis. A postoperative morbidity study

F Bauer^1,2, F Mghaieth³, N Dervaux¹, E Donal⁴, G Derumeaux⁵, A Cribier^1,2, J-P Bessou³

¹ Service de Cardiologie, Hôpital Charles Nicolle, Rouen, France
² Unité INSERM U644, Faculté de Médecine, Rouen, France
³ Service de Chirurgie cardiaque, Hôpital Charles Nicolle, Rouen, France
⁴ Service de Cardiologie, Hôpital Pontchai Ilou, Rennes, France
⁵ Service de Cardiologie, Hôpital Cardiologique, Lyon, France

Dr F Bauer, Service de Cardiologie, Echographie Cardiaque, Hôpital Charles Nicolle, 1 rue de Germont, 76031 Rouen Cedex, France; fabrice.bauer{at}chu-rouen.fr

Background: In a pressure overloaded left ventricle, regional systolic function has often deteriorated despite normal ejection fraction.

Objective: To correlate regional systolic function obtained by tissue Doppler imaging (TDI) with improvement in functional status after aortic valve replacement in patients with aortic stenosis (AS).

Methods and results: 24 hours before aortic valve replacement, 32 patients with severe AS underwent conventional and TDI echocardiography for systolic peak velocity, peak strain and peak strain rate measurement in the short-axis posterior wall. At follow-up, a composite end point of cardiovascular death, worsening of heart failure and limited exercise capacity was recorded. Before surgery, mean (SD) aortic valve area and pressure gradient were 0.69 (0.22) cm² and 50 (14) mm Hg, respectively. Ejection fraction was 61 (10)% and septal thickness was 15 (3) mm. Fourteen events were recorded but no cardiac death. By using the multivariate regression analysis, systolic peak strain rate (p = 0.003) was the strongest predictor of limited recovery after aortic valve replacement. The peak strain rate cut-off point was 2/s by receiver operating characteristic analysis.

Conclusion: Irrespective of ejection fraction and thickness, strain rate is a determinant which predicts recovery after aortic valve replacement in patients with severe AS.

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