Document Detail


Impact of valvuloarterial impedance on left ventricular longitudinal deformation in patients with aortic valve stenosis and preserved ejection fraction.
MedLine Citation:
PMID:  20656633     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Left ventricular (LV) longitudinal deformation is a good marker of intrinsic myocardial dysfunction in pressure overload cardiomyopathies.
AIM: To assess the effect of valvuloarterial haemodynamic load on LV longitudinal deformation in patients with aortic valve stenosis (AVS) and preserved LV ejection fraction (LVEF).
METHODS: Global LV longitudinal strain (GLS) was measured using speckle tracking imaging in a series of 82 consecutive patients with AVS (mean age 75+/-10 years; 50% men). The global (valvular+arterial) haemodynamic load imposed on the LV was estimated by the valvuloarterial impedance (Z(va)), and was calculated using either arm-cuff systolic peripheral blood pressure or systolic central aortic blood pressure estimated by SphygmoCor.
RESULTS: Among this series of 82 patients with preserved LVEF, 79% had reduced LV GLS (<-18%). LV GLS correlated weakly with AVS severity, systemic vascular resistance and systemic arterial compliance. However, there was a good inverse correlation between increase in Z(va) and impairment of LV GLS (r=0.41 p<0.0001). On multivariable analysis, impaired GLS was associated with increased Z(va) (p<0.0001), increased E/Ea ratio (p=0.001) and increased LV end-diastolic volume index (p=0.021), while indices of valvular load were not. Utilization of estimated central aortic blood pressure in place of brachial pressure did not improve the performance of Z(va) to predict GLS.
CONCLUSION: The magnitude of the global haemodynamic load as reflected by Z(va) is a powerful determinant of altered LV longitudinal deformation in AVS patients with preserved LVEF. The calculation of Z(va) may be useful to identify the patients who are potentially at higher risk for the development of myocardial dysfunction. Use of estimated central aortic pressure in the calculation of Z(va) does not appear to provide any incremental predictive value over that calculated with the simple measurement of brachial pressure.
Authors:
Sylvestre Maréchaux; Emilie Carpentier; Marie Six-Carpentier; Philippe Asseman; Thierry H LeJemtel; Brigitte Jude; Philippe Pibarot; Pierre Vladimir Ennezat
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-05-20
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  103     ISSN:  1875-2128     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-07-26     Completed Date:  2010-11-02     Revised Date:  2011-04-25    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  227-35     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Masson SAS. All rights reserved.
Affiliation:
Division of Cardiology, Centre hospitalier régional et universitaire de Lille, Lille 59037, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aorta / physiopathology*
Aortic Valve / physiopathology*,  ultrasonography
Aortic Valve Stenosis / complications,  physiopathology*,  ultrasonography
Blood Pressure
Blood Pressure Determination
Brachial Artery / physiopathology
Cross-Sectional Studies
Echocardiography, Doppler, Color
Echocardiography, Doppler, Pulsed
Female
Hemodynamics*
Humans
Linear Models
Male
Myocardial Contraction*
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke Volume*
Vascular Resistance
Ventricular Dysfunction, Left / etiology*,  physiopathology,  ultrasonography
Ventricular Function, Left*
Grant Support
ID/Acronym/Agency:
//Canadian Institutes of Health Research

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