Impact of left ventricular afterload on longitudinal dyssynchrony in patients with severe aortic stenosis and preserved ejection fraction.
BACKGROUND
The purpose of this study was to investigate whether patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) have dyssynchrony and whether it improves after aortic valve replacement (AVR).


RESULTS
We studied 30 consecutive patients with severe AS and preserved EF undergoing AVR. For baseline comparison, we studied 17 EF-matched patients with mild-to-moderate AS, and 18 EF-matched normal volunteers. Longitudinal dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain in apical 4- and 2-chamber views at the basal- and mid-levels. Radial and circumferential dyssynchrony was determined as the difference for time-to-peak strain between the anteroseptum and posterior wall from the mid-left ventricular (LV) short-axis view. Each of the myocardial functions was also evaluated by averaging each peak systolic strain. Longitudinal dyssynchrony and function in patients with severe AS was significantly worse than in the patients with mild-to-moderate AS and the controls (94 ± 46 vs. 66 ± 18 ms* and 52 ± 17 ms*, and 12.5 ± 3.7% vs. 16 ± 3.5%* and 18.7 ± 3.7%*, respectively, *P<0.05, vs. severe AS). In contrast, radial and circumferential dyssynchrony were similar for the 3 groups. Importantly, the dyssynchrony of patients with severe AS significantly improved after AVR from 94 ± 46 ms to 68 ± 22 ms (P<0.005).


CONCLUSIONS
Significant longitudinal dyssynchrony was present in patients with severe AS and preserved EF, and it improved after AVR.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Kohei
K
Yamawaki
Hidekazu
H
Tanaka
Kensuke
K
Matsumoto
Mana
M
Hiraishi
Tatsuya
T
Miyoshi
Akihiro
A
Kaneko
Takayuki
T
Tsuji
Keiko
K
Ryo
Kazuko
K
Norisada
Yuko
Y
Fukuda
Kazuhiro
K
Tatsumi
Tetsuari
T
Onishi
Kenji
K
Okada
Yutaka
Y
Okita
Hiroya
H
Kawai
Ken-ichi
K
Hirata
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*