Journal of the American Society of Echocardiography
Clinical InvestigationValvular Heart DiseaseDeterioration of Myocardial Function in Paradoxical Low-Flow Severe Aortic Stenosis: Two-Dimensional Strain Analysis
Section snippets
Patient Population
A total of 103 patients with severe AS and preserved LV ejection fractions (LVEFs; >50%) per the definition of AVA < 1.0 cm2 in the American College of Cardiology and American Heart Association guidelines were enrolled in the study irrespective of symptom status. Patients with significant concomitant valvular heart disease of grade ≥3 other than AS (i.e., concomitant aortic regurgitation or mitral, tricuspid, or pulmonic valve disease; significant regional wall motion abnormality; or history of
Results
Among 103 patients, 16 were classified as having PLF AS. Patients with PLF AS tended to have larger body surface areas, were less likely to have hypertension, and were more likely to have atrial fibrillation (Table 1). Interestingly, patients with PLF AS also tended to have worse functional status compared with those with NF AS (mean New York Heart Association functional capacity, 1.96 ± 0.62 for NF AS vs 2.38 ± 0.70 for PLF AS; P = .02).
Compared with the NF AS group, LVEFs were significantly
Discussion
The main findings of this study are that (1) patients with PLF AS showed significantly impaired myocardial function despite preserved LVEFs, as verified by GLS with the use of 2D speckle-tracking imaging; (2) global LV afterload, represented by Zva, may be a significant determinant of subclinical LV dysfunction in severe AS; and (3) GLS might be useful to corroborate the diagnosis PLF AS and also to predict the prognosis of severe AS.
Conclusions
GLS measured by 2D speckle-tracking imaging is depressed in patients with PLF AS. This implies that subclinical myocardial dysfunction is evident in these patients. It also suggests the possible diagnostic value of 2D global strain in PLF AS. In addition, global LV afterload is an important determinant of myocardial dysfunction in patients with severe AS.
Acknowledgments
We thank Seon-Jin Kim, RN, for her assistance in gathering the echocardiographic data and Ha-Young Joo, RN, for her help in management of the database. We are also indebted to the helpful assistance in statistical analysis from the Medical Research Collaborating Center, Seoul National University Hospital.
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