Severe aortic stenosis and myocardial function: diagnostic and prognostic usefulness of ultrasonic integrated backscatter analysis.
BACKGROUND
The aim of this study was to assess the myocardial reflectivity pattern in severe aortic valve stenosis through the use of integrated backscatter (IBS) analysis. Patients with aortic stenosis (AS) were carefully selected in the Department of Cardiology.


RESULTS
Thirty-five subjects (AS: valve orifice < or =1 cm2; 12 female; mean age, 71.8+/-6.2 years) and 25 healthy subjects were studied. All subjects of the study had conventional 2D-Doppler echocardiography and IBS. Backscatter signal was sampled at the septum and posterior wall levels. Patients with AS were divided into 2 groups: 16 patients with initial signs of congestive heart failure and a depressed left ventricular systolic function (DSF) (ejection fraction [EF] range, 35% to 50%) and 19 asymptomatic patients with normal left ventricular systolic function (NSF) (EF >50%). Myocardial echo intensity (pericardium related) was significantly higher at the septum and posterior wall levels in DSF than in NSF and in control subjects. IBS variation, as an expression of variation of the signal, appeared to be significantly lower in AS with DSF than in NSF and in control subjects, at both the septum and posterior wall levels. Patients with DSF underwent aortic valve replacement, and, during surgical intervention, a septal myocardial biopsy was made for evaluation of myocardium/fibrosis ratio. Abnormally increased echo intensity was detected in left ventricular pressure overload by severe aortic stenosis and correlated with increase of myocardial collagen content (operating biopsy).


CONCLUSIONS
One year after aortic valve replacement, we observed a significant reduction of left ventricular mass, and, only if pericardial indexed IBS value (reduction of interstitial fibrosis) decreased, it was possible to observe an improvement of EF and of IBS variation.
Di Bello
Vitantonio
V
Cardiac and Thoracic Department, University of Pisa, Italy. vdibello@med.unipi.it.
Giorgi
Davide
D
Viacava
Paolo
P
Enrica
Talini
T
Nardi
Carmela
C
Palagi
Caterina
C
Grazia Delle Donne
Maria
M
Verunelli
Francesco
F
Mariani
Massimo A
MA
Grandjean
Jean
J
Dell'Anna
Rita
R
Di Cori
Andrea
A
Zucchelli
Giulio
G
Romano
Maria Francesca
MF
Mariani
Mario
M
D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001706:Biopsy; D003094:Collagen / Q000032:analysis*; D003720:Densitometry; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler; D005260:Female; D005355:Fibrosis; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology; D006346:Heart Septum / Q000737:chemistry / Q000473:pathology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011184:Postoperative Period; D011312:Pressure; D011379:Prognosis; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
D003094:Collagen