title: Combined circumferential and longitudinal left ventricular systolic dysfunction in patients with asymptomatic aortic stenosis.
abstract: BACKGROUND
  Early detection of left ventricular (LV) systolic dysfunction is pivotal in the management of patients with aortic stenosis (AS). LV circumferential and/or longitudinal shortening may be impaired in these patients despite LV ejection fraction is preserved. We focused on prevalence and factors associated with combined impairment of circumferential and longitudinal shortening (C&L) in asymptomatic AS patients.
  
  
  METHODS
  Echocardiographic and clinical data from 200 patients with asymptomatic AS of any degree without history of heart failure and normal LV ejection fraction were analyzed. C&L were evaluated by mid-wall shortening (MS) and tissue Doppler mitral annular peak systolic velocity (S'), and classified low if <16.5% and if <8.5 cm/sec, respectively (10th percentiles of controls).
  
  
  RESULTS
  Combined C&L dysfunction was detected in 72 patients (36%). The variables associated with this condition were higher LV mass (OR 1.02 [CI 1.01-1.04], P = 0.03), concentric LV geometry (OR 4.30 [CI 1.79-10.34], P = 0.001), increasing pulmonary artery wedge pressure (by E/e' ratio; OR 1.11 [CI 1.04-1.19], P = 0.001). The relation of MS and peak S' was linear and slightly significant in the whole population (r = 0.23; F statistic=0.001), absent in patients with C&L dysfunction (r = 0.04; F = ns), negative (linear model) in the subgroup of patients without C&L dysfunction (r = -0.22; F = 0.02).
  
  
  CONCLUSIONS
  C&L dysfunction is present in more than one-third of patients with asymptomatic AS and is associated with concentric LV geometry and higher degree of diastolic dysfunction. The relation between MS and peak S' largely varies in the subgroups with different C&L function.
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, Trento, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.affiliation: Cardiovascular Center, Trieste and University of Trieste, Trieste, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.affiliation: Cardiovascular Center, Trieste and University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Division of Cardiology, Department of Medicine, University and Public Hospital, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Cardiology Service, CMSR Veneto Medical Center, Vicenza, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nistri
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, Trento, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ognibeni
authors.affiliation: Department of Cardiology, S. Martino Hospital, Belluno, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.affiliation: Cardiovascular Center, Trieste and University of Trieste, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Cardiology Unit, "Spedali Civili" Hospital, Brescia, Italy.
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.affiliation: Heart Failure Clinic, Division of Cardiology/C.C.U., San Camillo Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, Trento, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Stefenelli
authors.affiliation: Department of Translational Medical Sciences, Federico II, University Hospital, School of Medicine, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.affiliation: Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: aortic stenosis; calcium score; concentric hypertrophy; left ventricular mass; left ventricular systolic dysfunction; longitudinal function; mid-wall shortening