Document Detail


Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment.
MedLine Citation:
PMID:  16022957     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to determine to what extent systemic arterial compliance (SAC) might impact on afterload and left ventricular (LV) function in patients with aortic stenosis (AS). BACKGROUND: Although AS and reduced SAC may often coexist in the same patient, their relative impact on LV function is not well understood. METHODS: Systemic arterial compliance was calculated as the ratio of stroke volume index to arterial pulse pressure in 208 patients with at least moderate AS. As a measure of global afterload, we calculated the valvulo-arterial impedance (Zva), which theoretically accounts for the effects of both AS and SAC. RESULTS: Patients were divided into four groups: group 1, moderate AS and normal SAC (n = 77; 37%); group 2, moderate AS and low SAC (n = 50; 24%); group 3, severe AS and normal SAC (n = 45; 22%); and group 4, severe AS and low SAC (n = 36; 17%). The prevalences of LV diastolic and systolic dysfunction were 60% and 6% in group 1, 86% and 12% in group 2, 82% and 16% in group 3, and 94% and 31% in group 4. In multivariate analysis excluding Zva, energy loss index and SAC were both independent predictors of LV dysfunction, but when Zva was entered into the analyses, it became the only hemodynamic variable to be independently associated with LV dysfunction. CONCLUSIONS: Reduced SAC is a frequent occurrence in elderly patients with AS, where it independently contributes to increased afterload and decreased LV function. Systemic arterial compliance should be taken into consideration when evaluating these patients with regard to diagnosis and treatment.
Authors:
Martin Briand; Jean G Dumesnil; Lyes Kadem; Antonio G Tongue; Régis Rieu; Damien Garcia; Philippe Pibarot
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  46     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-18     Completed Date:  2005-08-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  291-8     Citation Subset:  AIM; IM    
Affiliation:
Research Group in Valvular Heart Diseases, Research Center of Laval Hospital/Quebec Heart Institute, Department of Medicine, Laval University, Sainte-Foy, Quebec, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve Stenosis / physiopathology*
Arteries / physiopathology*
Case-Control Studies
Compliance
Electrocardiography
Female
Hemodynamics / physiology
Humans
Male
Multivariate Analysis
Prevalence
Pulse
Retrospective Studies
Stroke Volume / physiology
Ventricular Dysfunction, Left / epidemiology*,  physiopathology
Ventricular Function, Left / physiology
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2005 Jul 19;46(2):299-301   [PMID:  16022958 ]

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