Myocardial function in severe aortic stenosis before and after aortic valve replacement: A Doppler tissue imaging study
Section snippets
Study population
Two groups of strictly age-matched men were prospectively studied (case control study): 35 patients with AS, selected in our cardiac department (AS valve orifice ≤ 1 cm2) (12 female), mean age 71.8 ± 6.2 years; and 35 healthy participants of comparable age (70.5 ± 5.5 years), sex (9 female), and body mass index (AS group 25.5 ± 2.7 vs control group 24.6 ± 3.7; not significant). Apart from no previous myocardial infarction, a negative history of renal and connective tissue disease, and serum
Results
BP and heart rate overlapped in AS and control groups (Table 1). Interventricular septum and posterior wall thickness were greater in AS, and LVMbs and LVM normalized for height were significantly higher in AS subgroups in comparison with the control group (Table 2). LV end-diastolic diameter was slightly higher in AS I group in comparison with AS II and control groups. Meridional end-S stress was significantly higher in AS groups. E/A ratio was significantly higher in the control group. A VTI
Discussion
Age-related degenerative changes appreciably alter the anatomy and function of the aortic valve; especially in patients older than 65 years, the aortic annular tissue tends to thicken and to acquire calcific deposit. Such a degenerative calcification of an otherwise normal-appearing aortic valve with 3 cusps may result in progressive AS. To compensate for the increased pressure workload caused by AS, the myocardium undergoes to LV hypertrophy.14 It realizes an increase in myocytic size yielding
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Cited by (35)
Determinants of left atrial volume index in patients with aortic stenosis: A multicentre pilot study
2017, Archives of Cardiovascular DiseasesCitation Excerpt :However, reduction in LV ejection fraction is a late event in the natural history of AS, and most patients with severe AS have a normal LV ejection fraction, even when symptoms are present. Conversely, LV hypertrophy and abnormal LV diastolic function are common findings in these patients before LV ejection fraction impairment occurs [4–6]. Left atrial (LA) enlargement is a recognized marker of increased LV filling pressures [7], and is frequent in patients with severe AS [8,9], so that in the absence of mitral valve disease or atrial fibrillation, it reflects the severity and duration of the disease [10].
Left atrial volume index in patients with asymptomatic severe aortic stenosis
2014, Egyptian Heart JournalLongitudinal left ventricular 2D strain is superior to ejection fraction in predicting myocardial recovery and symptomatic improvement after aortic valve implantation
2013, International Journal of CardiologyCitation Excerpt :This was confirmed by our data, demonstrating in a large contemporary series of TAVI patients that EF was reduced in only 32% while longitudinal function was impaired in 57% of patients. When studies also reported post-interventional (mostly postoperative) data, longitudinal function improved in general [8–11,13,14,18,19]. There is, however, controversy whether this is mainly due to afterload change [18] or due to changes of the myocardium itself (i.e. regression of left ventricular hypertrophy or fibrosis, improvement of intrinsic myocardial function) [11,30,31].
Asymmetric septal hypertrophy in patients with severe aortic stenosis: The usefulness of associated septal myectomy
2013, Journal of Thoracic and Cardiovascular SurgeryImprovement 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
2010, Journal of the American Society of EchocardiographyRelation of left atrial dysfunction to pulmonary artery hypertension in patients with aortic stenosis and left ventricular systolic dysfunction
2010, American Journal of CardiologyCitation Excerpt :The passive LA emptying fraction is decreased, and the active LA emptying volume is increased.1 The A-wave velocity is also greater in those with aortic stenosis than in age- and LV systolic function-matched controls.21,22 Therefore, most patients with aortic stenosis have an increased atrial contribution to LV filling.22