Giovanni Cioffi1, Carmine Mazzone2, Giulia Barbati2, Andrea Rossi3, Stefano Nistri4, Federica Ognibeni1, Luigi Tarantini5, Andrea Di Lenarda2, Pompilio Faggiano6, Giovanni Pulignano7, Carlo Stefenelli1, Giovanni de Simone8, Richard B Devereux9. 1. Department of Cardiology, Villa Bianca Hospital, Trento, Italy. 2. Cardiovascular Center, Trieste and University of Trieste, Trieste, Italy. 3. Division of Cardiology, Department of Medicine, University and Public Hospital, Verona, Italy. 4. Cardiology Service, CMSR Veneto Medical Center, Vicenza, Italy. 5. Department of Cardiology, S. Martino Hospital, Belluno, Italy. 6. Cardiology Unit, "Spedali Civili" Hospital, Brescia, Italy. 7. Heart Failure Clinic, Division of Cardiology/C.C.U., San Camillo Hospital, Rome, Italy. 8. Department of Translational Medical Sciences, Federico II, University Hospital, School of Medicine, Naples, Italy. 9. Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York.
Abstract
BACKGROUND: Early detection of left ventricular (LV) systolic dysfunction is pivotal in the management of patients with aortic stenosis (AS). LV circumferential and/or longitudinal shortening may be impaired in these patients despite LV ejection fraction is preserved. We focused on prevalence and factors associated with combined impairment of circumferential and longitudinal shortening (C&L) in asymptomatic AS patients. METHODS: Echocardiographic and clinical data from 200 patients with asymptomatic AS of any degree without history of heart failure and normal LV ejection fraction were analyzed. C&L were evaluated by mid-wall shortening (MS) and tissue Doppler mitral annular peak systolic velocity (S'), and classified low if <16.5% and if <8.5 cm/sec, respectively (10th percentiles of controls). RESULTS: Combined C&L dysfunction was detected in 72 patients (36%). The variables associated with this condition were higher LV mass (OR 1.02 [CI 1.01-1.04], P = 0.03), concentric LV geometry (OR 4.30 [CI 1.79-10.34], P = 0.001), increasing pulmonary artery wedge pressure (by E/e' ratio; OR 1.11 [CI 1.04-1.19], P = 0.001). The relation of MS and peak S' was linear and slightly significant in the whole population (r = 0.23; F statistic=0.001), absent in patients with C&L dysfunction (r = 0.04; F = ns), negative (linear model) in the subgroup of patients without C&L dysfunction (r = -0.22; F = 0.02). CONCLUSIONS: C&L dysfunction is present in more than one-third of patients with asymptomatic AS and is associated with concentric LV geometry and higher degree of diastolic dysfunction. The relation between MS and peak S' largely varies in the subgroups with different C&L function.
BACKGROUND: Early detection of left ventricular (LV) systolic dysfunction is pivotal in the management of patients with aortic stenosis (AS). LV circumferential and/or longitudinal shortening may be impaired in these patients despite LV ejection fraction is preserved. We focused on prevalence and factors associated with combined impairment of circumferential and longitudinal shortening (C&L) in asymptomatic AS patients. METHODS: Echocardiographic and clinical data from 200 patients with asymptomatic AS of any degree without history of heart failure and normal LV ejection fraction were analyzed. C&L were evaluated by mid-wall shortening (MS) and tissue Doppler mitral annular peak systolic velocity (S'), and classified low if <16.5% and if <8.5 cm/sec, respectively (10th percentiles of controls). RESULTS: Combined C&L dysfunction was detected in 72 patients (36%). The variables associated with this condition were higher LV mass (OR 1.02 [CI 1.01-1.04], P = 0.03), concentric LV geometry (OR 4.30 [CI 1.79-10.34], P = 0.001), increasing pulmonary artery wedge pressure (by E/e' ratio; OR 1.11 [CI 1.04-1.19], P = 0.001). The relation of MS and peak S' was linear and slightly significant in the whole population (r = 0.23; F statistic=0.001), absent in patients with C&L dysfunction (r = 0.04; F = ns), negative (linear model) in the subgroup of patients without C&L dysfunction (r = -0.22; F = 0.02). CONCLUSIONS: C&L dysfunction is present in more than one-third of patients with asymptomatic AS and is associated with concentric LV geometry and higher degree of diastolic dysfunction. The relation between MS and peak S' largely varies in the subgroups with different C&L function.
Authors: Giovanni Pulignano; Michele Massimo Gulizia; Samuele Baldasseroni; Francesco Bedogni; Giovanni Cioffi; Ciro Indolfi; Francesco Romeo; Adriano Murrone; Francesco Musumeci; Alessandro Parolari; Leonardo Patanè; Paolo Giuseppe Pino; Annalisa Mongiardo; Carmen Spaccarotella; Roberto Di Bartolomeo; Giuseppe Musumeci Journal: Eur Heart J Suppl Date: 2017-05-02 Impact factor: 1.803