Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study.
Aortic stenosis; Echocardiography; Left ventricular function
Abstract :
[en] Aims: 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.
<br />Methods and results: 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 lowflow as determined by a low stroke volume index (35 mL/m2). By multivariable analysis, four variables emerged as independently associated with low-flow AS: peak Ea velocity (P 1⁄4 0.01), left atrial area index (P 1⁄4 0.017), global LV afterload (P 1⁄4 0.024), and circumferential myocardial deformation (P 1⁄4 0.04). Forty-nine patients (28%) had an increased global LV afterload (5 mmHg mL/m2). Systemic arterial compliance (P 1⁄4 0.001), circumferential myocardial deformation (P 1⁄4 0.024), and left atrial area index (P 1⁄4 0.04) were independently associated with increased global LV load in multivariable analysis.
<br />Conclusion: In asymptomatic patients with severe AS, LV ejection fraction markedly underestimates the extent of myocardial sys- tolic impairment. Intrinsic myocardial dysfunction is particularly common in patients with increased global LV after- load, and especially in the subset of patients with low-flow AS.
Research Center/Unit :
Service de Cardiologie
Disciplines :
General & internal medicine Cardiovascular & respiratory systems
Magne, Julien ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
O'Connor, Kim
Moonen, Marie ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Cosyns, Bernard
Pierard, Luc ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Language :
English
Title :
Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study.
Otto CM. Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol 2006;47:2141-2151
Rosenhek R, Binder T, Porenta G, Lang I, Christ G, Schemper M et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 2000;343: 611-617
Vinereanu D, Nicolaides E, Boden L, Payne N, Jones CJ, Fraser AG. Conduit arterial stiffness is associated with impaired left ventricular subendocardial function. Heart 2003;89:449-450
Briand M, Dumesnil JG, Kadem L, Tongue AG, Rieu R, Garcia D et al. Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment. J Am Coll Cardiol 2005;46:291-298
Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P. Paradoxical low flow, low gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation 2007;115:2856-2864
Cramariuc D, Cioffi G, Rieck AE, Devereux RB, Staal EM, Ray S et al. Low-flow aortic stenosis in asymptomatic patients: valvular-arterial impedance and systolic function from the SEAS substudy. JACC Cardiovasc Imaging 2009;2:390-399
Hachicha Z, Dumesnil JG, Pibarot P. Usefulness of the valvuloarterial impedance to predict adverse outcome in asymptomatic aortic stenosis. J Am Coll Cardiol 2009;54:1003-1011
Lafitte S, Perlant M, Reant P, Serri K, Douard H, DeMaria A et al. Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr 2009;10:414-419
Lancellotti P, Cosyns B, Zacharakis D, Attena E, Van Camp G, Gach O et al. Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: assessment by two-dimensional speckle tracking. J Am Soc Echocardiogr 2008;21:1331-1336
Cramariuc D, Gerdts E, Davidsen ES, Segadal L, Matre K. Myocardial deformation in aortic valve stenosis-relation to left ventricular geometry. Heart 2010;96: 106-112
Skjaerpe T, Hegrenaes L, Hatle L. Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circulation 1985;72:810-818
Lancellotti P, Lebois F, Simon M, Tombeux C, Chauvel C, Pierard LA. Prognostic importance of quantitative exercise Doppler echocardiography in asymptomatic valvular aortic stenosis. Circulation 2005;112:I377-82.
Lancellotti P, Karsera D, Tumminello G, Lebois F, Piérard LA. Determinants of an abnormal response to exercise in patients with asymptomatic valvular aortic stenosis. Eur J Echocardiogr 2008;9:338-343
Lancellotti P, Senechal M, Moonen M, Donal E, Magne J, Nellessen E et al. Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy. Eur J Echocardiogr 2009;10:663-668
Palmieri V, Russo C, Buonomo A, Palmieri EA, Celentano A. Novel wall motion score-based method for estimating global left ventricular ejection fraction: validation by real-time 3D echocardiography and global longitudinal strain. Eur J Echocardiogr 2009; [Epub ahead of print].
Dalen H, Thorstensen A, Aase SA, Ingul CB, Torp H, Vatten LJ et al. Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: the HUNT study in Norway. Eur J Echocardiogr 2009; [Epub ahead of print].
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009;10:165-193
Dumesnil JG, Pibarot P, Carabello B. Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatment. Eur Heart J 2010;31:281-289
Pibarot P, Dumesnil JG. Longitudinal myocardial shortening in aortic stenosis: ready for prime time after thirty years of research? Heart 2010;96:95-96
Tongue AG, Dumesnil JG, Laforest I, Thériault C, Durand LG, Pibarot P. Left ventricular longitudinal shortening in patients with aortic stenosis: relationship with symptomatic status. J Heart Valve Dis 2003;12:142-149
Donal E, Bergerot C, Thibault H, Ernande L, Loufoua J, Augeul L et al. Influence of afterload on left ventricular radial and longitudinal systolic functions: a two-dimensional strain imaging study. Eur J Echocardiogr 2009;10: 914-921
Popescu BA, Calin A, Beladan CC, Muraru D, Rosca M, Deleanu D et al. Left ventricular torsional dynamics in aortic stenosis: relationship between left ventricular untwisting and filling pressures. A two-dimensional speckle tracking study. Eur J Echocardiogr 2010; [Epub ahead of print].
Hein S, Arnon E, Kostin S, Schönburg M, Elsässer A, Polyakova V et al. Progression from compensated hypertrophy to failure in the pressure-overloaded human heart: structural deterioration and compensatory mechanisms. Circulation 2003; 107:984-991
Van Pelt NC, Stewart RA, Legget ME, Whalley GA, Wong SP, Zeng I et al. Longitudinal left ventricular contractile dysfunction after exercise in aortic stenosis. Heart 2007;93:732-738
Monin JL, Lancellotti P, Monchi M, Lim P, Weiss E, Piérard L et al. Risk score for predicting outcome in patients with asymptomatic aortic stenosis. Circulation 2009;120:69-75.
