Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study
Open Access
- 4 March 2010
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal - Cardiovascular Imaging
- Vol. 11 (6), 537-543
- https://doi.org/10.1093/ejechocard/jeq014
Abstract
The present study sought to assess the effect of global left ventricular (LV) afterload on LV myocardial systolic function in patients with aortic stenosis (AS) and preserved LV ejection fraction. We prospectively examined the LV myocardial deformation (i.e. longitudinal, radial, and circumferential) by two-dimensional speckle tracking in 173 patients with asymptomatic severe AS. Thirty-eight patients (22%) had low flow as determined by a low stroke volume index (≤35 mL/m 2 ). By multivariable analysis, four variables emerged as independently associated with low-flow AS: peak Ea velocity ( P = 0.01), left atrial area index ( P = 0.017), global LV afterload ( P = 0.024), and circumferential myocardial deformation ( P = 0.04). Forty-nine patients (28%) had an increased global LV afterload (≥5 mmHg mL/m 2 ). Systemic arterial compliance ( P = 0.001), circumferential myocardial deformation ( P = 0.024), and left atrial area index ( P = 0.04) were independently associated with increased global LV load in multivariable analysis. Of note, LV ejection fraction was not identified as a determinant of low flow or increased afterload. In asymptomatic patients with severe AS, LV ejection fraction markedly underestimates the extent of myocardial systolic impairment. Intrinsic myocardial dysfunction is particularly common in patients with increased global LV afterload, and especially in the subset of patients with low-flow AS.Keywords
This publication has 20 references indexed in Scilit:
- Usefulness of the Valvuloarterial Impedance to Predict Adverse Outcome in Asymptomatic Aortic StenosisJournal of the American College of Cardiology, 2009
- Myocardial deformation in aortic valve stenosis: relation to left ventricular geometryHeart, 2009
- Low-Flow Aortic Stenosis in Asymptomatic Patients: Valvular–Arterial Impedance and Systolic Function From the SEAS SubstudyJACC: Cardiovascular Imaging, 2009
- Importance of Left Ventricular Longitudinal Function and Functional Reserve in Patients With Degenerative Mitral Regurgitation: Assessment by Two-Dimensional Speckle TrackingJournal of the American Society of Echocardiography, 2008
- Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosisEuropean Heart Journal - Cardiovascular Imaging, 2008
- Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis Despite Preserved Ejection Fraction Is Associated With Higher Afterload and Reduced SurvivalCirculation, 2007
- Valvular Aortic Stenosis: Disease Severity and Timing of InterventionJournal of the American College of Cardiology, 2006
- Reduced Systemic Arterial Compliance Impacts Significantly on Left Ventricular Afterload and Function in Aortic Stenosis: Implications for Diagnosis and TreatmentJournal of the American College of Cardiology, 2005
- Conduit arterial stiffness is associated with impaired left ventricular subendocardial functionHeart, 2003
- Predictors of Outcome in Severe, Asymptomatic Aortic StenosisThe New England Journal of Medicine, 2000