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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