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Longitudinal left ventricular contractile dysfunction after exercise in aortic stenosis
  1. Niels Van Pelt (n.vanpelt{at}erasmusmc.nl)
  1. Middlemore Hospital and Green Lane Cardiovascular Service, Auckland, New Zealand
    1. Ralph Stewart (rstewart{at}adhb.govt.nz)
    1. Green Lane Cardiovascular Service, University of Auckland, New Zealand
      1. Malcolm Legget (malcolml{at}adhb.govt.nz)
      1. Green Lane Cardiovascular Service, University of Auckland, New Zealand
        1. Gillian A Whalley (g.whalley{at}auckland.ac.nz)
        1. Green Lane Cardiovascular Service, University of Auckland, New Zealand
          1. Selwyn P Wong (spwong{at}middlemore.co.nz)
          1. Middlemore Hospital, Auckland, New Zealand
            1. Irene Zeng (irenez{at}adhb.govt.nz)
            1. Green Lane Cardiovascular Service, University of Auckland, New Zealand
              1. Margaret Oldfield (margareto{at}middlemore.co.nz)
              1. Middlemore Hospital, Auckland, New Zealand
                1. Andrew J Kerr (ajkerr{at}middlemore.co.nz)
                1. Middlemore Hospital, Auckland, New Zealand

                  Abstract

                  Objective To determine whether longitudinal left ventricular (LV) systolic function measured by Doppler tissue imaging after exercise can identify early left ventricular dysfunction in asymptomatic patients with moderate-severe aortic stenosis (AS).

                  Design Case-control study.

                  Setting Outpatient cardiology departments.

                  Patients 20 AS patients with no or equivocal symptoms, a peak aortic valve velocity ≥3.0m/s, and LV ejection fraction >50%, and 15 aged matched normal controls.

                  Interventions Echocardiography performed at rest and immediately after treadmill exercise.

                  Main outcome measures The peak systolic velocity of the lateral mitral annulus (S¡¯) by Doppler tissue imaging at rest and immediately after exercise, exercise capacity, exercise systolic blood pressure and the plasma level of B-type natriuretic peptide (BNP).

                  Results For AS patients mean(iÀSD) aortic valve area were 0.95 iÀ0.3cm2. At rest S¡¯ was similar for patients with AS and controls respectively (8.5¡À1.5 vs 9.1¡À1.8 cm/s, p=0.15). However after exercise S¡¯ (12.2iÀ3.2 vs 17.0iÀ2.8 cm/s, p<0.0001) and the increase in S¡¯ between rest and exercise (4.0iÀ3.0 vs 7.9iÀ1.5 cm/s, p<0.0001) were lower in AS. In patients with AS a smaller increase in S¡¯ after exercise was associated with lower exercise capacity (r=0.50, p=0.02), a smaller increase in exercise systolic blood pressure (r=0.60, p=0.005) and higher plasma level of BNP (r=0.66, p=0.0015).

                  Conclusion In asymptomatic patients with moderate-severe AS a lower than normal increase in peak systolic mitral annular velocity after treadmill exercise is a marker of early LV systolic dysfunction.

                  • B-type natriuretic peptide
                  • Doppler tissue imaging
                  • aortic stenosis
                  • left ventricular longitudinal function

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