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

Fabrice Bauer ^1*, Fathia Zghal ², Nathalie Dervaux ¹, Erwan Donal ³, Geneviève Derumeaux ⁴, Alain Cribier ¹ and Jean-Paul Bessou ¹

¹ Rouen University Hospital, France
² Habib Thameur hospital, Tunisia
³ CHU Rennes, France
⁴ Hôpital Cardiologique Louis Pradel, BRON, France

^* To whom correspondence should be addressed. E-mail: fabrice.bauer{at}chu-rouen.fr.

Accepted 27 November 2007

Abstract

Background In pressure overloaded left ventricle, regional systolic function is frequently deteriorated despite normal ejection fraction. We aimed to correlate regional systolic function obtained by tissue Doppler imaging (TDI) to 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 tissue Doppler imaging 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 cardio-vascular death, worsening of heart failure and limited exercise capacity was recorded. Before surgery, aortic valve area and mean pressure gradient were 0.69iÓ0.22 cm sq and 50iÓ14 mm Hg, respectively. Ejection fraction was 61iÓ10% and septal thickness was 15iÓ3 mm. We recorded 14 events 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 was 2.s-1 by ROC analysis.

Conclusion Irrespective of ejection fraction and thickness, strain rate is determinant to predict recovery after aortic valve replacement in patients with severe aortic stenosis

Keywords: Aortic stenosis, echocardiography, prognosis, tissue Doppler imaging

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