title: Evaluation of left ventricular diastolic function after valve replacement in aortic stenosis using exercise Doppler echocardiography.
abstract: BACKGROUND
  The aim of the present study was to evaluate the mechanism of diastolic dysfunction (DD) after aortic valve replacement (AVR) in patients with aortic stenosis (AS).
  
  
  RESULTS
  Supine bicycle exercise Doppler echocardiography (EDE) with measurement of early diastolic peak velocities of transmitral flow (E) and mitral septal annular movement (E') was performed in 38 patients with AS at least 24 months after AVR and in 19 sex- and age-matched normal controls. AS patients had a 27.4±32.7% decrease in the ratio of left ventricular (LV) mass index to LV end-diastolic volume index (LVMI/LVEDVI) after AVR. Pre-AVR E' was significantly lower in AS patients (4.3±1.6 cm/s vs. 7.7±1.6 cm/s, P<0.005), resulting in a higher E/E' (16.7±5.4 vs. 9.3±1.8, P<0.001). E/E' at rest did not change significantly after AVR. Both E and E' increased progressively with exercise, and the increase in E' (P<0.001) but not E (P=0.675) was greater in normal controls than in AS patients (P<0.001). Peak E/E' >13 during EDE was more common in AS patients than in controls (89.5%, 34/39 vs. 0%, 0/19, P<0.001). On multivariate analysis, LVMI/LVEDVI (Y=8.703+4.199X, r=0.433, P=0.001) was the only factor associated with peak E/E' during EDE.
  
  
  CONCLUSIONS
  Persistent DD is present after AVR, due primarily to failure in normal physiologic augmentation of LV relaxation during exercise, associated with incomplete or inadequate regression of LV hypertrophy.
authors.affiliation: Inje University Busan Paik Hospital, Busan, South Korea.
authors.forename: Jeong-Sook
authors.initials: JS
authors.lastname: Seo
authors.forename: Min-Kyoung
authors.initials: MK
authors.lastname: Jang
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Lee
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001642:Bicycling; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003971:Diastole; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D013318:Stroke Volume; D016683:Supine Position; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling