Longitudinal left ventricular contractile dysfunction after exercise in aortic stenosis.
OBJECTIVE
To determine whether longitudinal left ventricular systolic function measured by Doppler tissue imaging (DTI) after exercise can identify early left ventricular dysfunction in asymptomatic patients with moderate-severe aortic stenosis.


METHODS
Case-control study.


METHODS
Outpatient cardiology departments.


METHODS
20 patients with aortic stenosis, with or without equivocal symptoms, a peak aortic valve velocity > or =3 m/s, and left ventricular ejection fraction >50% and 15 aged-matched normal controls.


METHODS
Echocardiogram performed at rest and immediately after treadmill exercise.


METHODS
The peak systolic velocity of the lateral mitral annulus (S') by DTI at rest and immediately after exercise, exercise capacity, exercise systolic blood pressure and the plasma level of B-type natriuretic peptide (BNP).


RESULTS
For patients with aortic stenosis, mean (SD) aortic valve area was 0.95 (0.3) cm(2). At rest, S' was similar for patients with aortic stenosis and controls, respectively (8.5 (1.5) vs 9.1 (1.8) cm/s, p = 0.15). However, after exercise, S' (12.2 (3.2) vs 17 (2.8) cm/s, p<0.001) and the increase in S' between rest and exercise (4 (3) vs 7.9 (1.5) cm/s, p<0.001) were lower in patients with aortic stenosis. In patients with aortic stenosis, a smaller increase in S' after exercise was associated with lower exercise capacity (r = 0.5, p = 0.02), a smaller increase in exercise systolic blood pressure (r = 0.6, p = 0.005) and higher plasma level of BNP (r = 0.66, p = 0.002).


CONCLUSIONS
In asymptomatic patients with moderate-severe aortic stenosis a lower than normal increase in peak systolic mitral annular velocity after treadmill exercise is a marker of early left ventricular systolic dysfunction.
Van Pelt
Niels C
NC
Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.
Stewart
Ralph A H
RA
Legget
Malcolm E
ME
Whalley
Gillian A
GA
Wong
Selwyn P
SP
Zeng
Irene
I
Oldfield
Margaret
M
Kerr
Andrew J
AJ
D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001794:Blood Pressure; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D015444:Exercise / Q000502:physiology*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000502:physiology; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging
D020097:Natriuretic Peptide, Brain