title: Aortic valve replacement in patients with aortic valve stenosis improves myocardial metabolism and diastolic function.
abstract: OBJECTIVE
  To evaluate whether functional and metabolic changes recover after aortic valve replacement (AVR).
  
  
  METHODS
  Eighteen men with aortic valve stenosis (mean pressure gradient +/- SD, 79.9 mm Hg +/- 15.1) underwent magnetic resonance (MR) imaging and phosphorus 31 MR spectroscopy. In nine patients who underwent AVR, MR imaging and spectroscopy were repeated 40 weeks +/- 12 after AVR. Ten age-matched healthy men were control subjects.
  
  
  RESULTS
  Before AVR, the myocardial phosphocreatine (PCr)-to-adenosine triphosphate (ATP) ratio in the 18 patients was 1.24 +/- 0.17 and 1.43 +/- 0.14 in the control group (P <.01). In nine patients who underwent follow-up MR spectroscopy, the ratio increased from 1.28 +/- 0.17 to 1.47 +/- 0.14 (P <.05) following AVR. Before AVR, early acceleration peak corrected for cardiac output was (0.043 +/- 0.008) x 10(-3) sec(-1) in patients and (0.081 +/- 0.033) x 10(-3) sec(-1) in the control group (P <.05). After 40 weeks +/- 12, the mean early acceleration peak corrected for cardiac output in the nine patients increased significantly to (0.055 +/- 0.006) x 10(-3) sec(-1) (P <.05), although it was still significantly lower than that of the control group (P <.05). Before AVR, a significant correlation was found between the myocardial PCr-ATP ratio and left ventricular diastolic function (n = 18; P <.05).
  
  
  CONCLUSIONS
  Severe aortic valve stenosis leads to a decreased myocardial PCr-ATP ratio and impairment of left ventricular diastolic function; following AVR, the ratio normalizes completely, whereas function improves significantly. There is an association between altered myocardial high-energy phosphate metabolism and impaired left ventricular diastolic function.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 2A Leiden, the Netherlands.
authors.forename: H P
authors.initials: HP
authors.lastname: Beyerbacht
authors.forename: H J
authors.initials: HJ
authors.lastname: Lamb
authors.forename: A
authors.initials: A
authors.lastname: van Der Laarse
authors.forename: H W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: F
authors.initials: F
authors.lastname: Leujes
authors.forename: M G
authors.initials: MG
authors.lastname: Hazekamp
authors.forename: A
authors.initials: A
authors.lastname: de Roos
authors.forename: E E
authors.initials: EE
authors.lastname: van Der Wall
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D016022:Case-Control Studies; D003971:Diastole / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009206:Myocardium / Q000378:metabolism*; D010725:Phosphocreatine / Q000378:metabolism; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D010725:Phosphocreatine; D000255:Adenosine Triphosphate