Document Detail


Left ventricular systolic and diastolic function assessed by tissue Doppler imaging and outcome in asymptomatic aortic stenosis.
MedLine Citation:
PMID:  20513730     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
AIMS: Left ventricular (LV) hypertrophy and abnormal non-invasive measures of LV diastolic function are common in patients with severe aortic stenosis (AS) but their prognostic importance is uncertain. This study aimed to determine whether tissue Doppler measures of LV systolic and/or diastolic function or echocardiographic LV hypertrophy are useful for risk stratifying asymptomatic patients with severe calcific AS.
METHODS AND RESULTS: One hundred and eighty-three initially asymptomatic patients with moderate or severe AS (valve area mean 0.96 ± SD 0.3 cm(2)) and a normal LV ejection fraction were followed for median 31 (IQR 14-40) months. Peak systolic (S') and diastolic (E') mitral annular velocities and LV mass were measured by echocardiography at baseline and during follow-up. During follow-up 106 (58%) patients suffered symptomatic deterioration, including three sudden deaths and one resuscitated cardiac arrest. Peak aortic velocity (for 0.5 m/s increase HR = 1.43, 95% CI 1.25, 1.64, P < 0.0001) and aortic valve area (-0.1 cm(2)/m(2) HR = 1.23, 95% CI 1.12, 1.35, P = 0.004) at baseline were most strongly associated with symptomatic deterioration. After peak aortic velocity adjustment neither LV mass index nor any measure of LV systolic or diastolic function was associated with symptomatic deterioration (P > 0.2 for all).
CONCLUSION: In patients with calcific AS who have a normal LV ejection fraction the severity of stenosis is the most important correlate of symptomatic deterioration. Tissue Doppler measures of LV systolic and diastolic function and LV mass provide limited predictive information after accounting for the severity of stenosis.
Authors:
Ralph A H Stewart; Andrew J Kerr; Gillian A Whalley; Malcolm E Legget; Irene Zeng; Michael J A Williams; John Lainchbury; Andrew Hamer; Robert Doughty; Mark A Richards; Harvey D White;
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-05-31
Journal Detail:
Title:  European heart journal     Volume:  31     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2216-22     Citation Subset:  IM    
Affiliation:
Green Lane Cardiovascular Research, Auckland City Hospital, Auckland, New Zealand. RStewart@adhb.govt.nz
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MeSH Terms
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Investigator
Investigator/Affiliation:
Dennis Freidlander / ; Richard Luke / ; Colin Edwards / ; Tim O'Meagan / ; Mark Simmonds / ; Mark Richards /
Comments/Corrections
Comment In:
Eur Heart J. 2010 Sep;31(18):2191-3   [PMID:  20558429 ]

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