Document Detail

Valve replacement for aortic stenosis normalizes subendocardial function in patients with normal ejection fraction.
MedLine Citation:
PMID:  20219771     Owner:  NLM     Status:  MEDLINE    
AIMS: Long-standing aortic stenosis (AS) causes various degrees of left ventricular (LV) dysfunction, which may improve after valve replacement. The aim of this study was to assess the nature of LV subendocardial abnormalities in AS and their response to valve replacement (AVR).
METHODS AND RESULTS: We studied 41 consecutive symptomatic patients (age 64 +/- 13 years) with severe AS, normal LV ejection fraction (EF), but no obstructive coronary artery disease before, a week after AVR, and 6 months after AVR. LV subendocardial function was studied from recordings of long-axis M-mode (amplitude), tissue-Doppler (myocardial velocities) and speckle tracking (myocardial strain) echocardiographic techniques. Results were compared with those from 20 age- and gender-matched controls. In patients, LV dimensions and markers of asynchrony, total isovolumic time (t-IVT), and Tei index were not different from controls before AVR and remained unchanged afterwards. LV lateral long-axis amplitude, as well as lateral and septal systolic velocities and strain, were reduced (P < 0.001 for all) and E/E' was modestly raised. Lateral long-axis amplitude, systolic and diastolic velocities normalized within a week of AVR but strain lagged behind until 6 months later. The reduced septal long-axis amplitude remained permanently unchanged (NS) despite the early normalization of its systolic velocities (P < 0.001) and strain (P < 0.001). LV mass normalized at 6 months after AVR (P < 0.005).
CONCLUSIONS: In patients with severe AS and maintained LV ejection fraction, subendocardial function is globally abnormal showing reduced amplitude of motion, velocities, and strain. The different response of its components suggests an evidence for differential reverse remodelling, irrespective of myocardial mass regression.
Per Lindqvist; Gani Bajraktari; Roberta Molle; Elizabetta Palmerini; Anders Holmgren; Sergio Mondillo; Michael Y Henein
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2010-03-10
Journal Detail:
Title:  European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology     Volume:  11     ISSN:  1532-2114     ISO Abbreviation:  Eur J Echocardiogr     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-06     Completed Date:  2010-12-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100890618     Medline TA:  Eur J Echocardiogr     Country:  England    
Other Details:
Languages:  eng     Pagination:  608-13     Citation Subset:  IM    
Heart Centre, Umeå, Sweden.
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MeSH Terms
Aged, 80 and over
Aortic Valve* / surgery,  ultrasonography
Aortic Valve Stenosis / physiopathology,  surgery*,  ultrasonography*
Case-Control Studies
Endocardium / ultrasonography*
Heart Valve Prosthesis*
Middle Aged
Postoperative Care
Predictive Value of Tests
Preoperative Care
Sensitivity and Specificity
Severity of Illness Index
Stroke Volume*
Treatment Outcome
Ventricular Function, Left*

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