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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery

Published on: November 28, 2018

Determinants of left ventricular hypertrophy and oxygen supply in chronic aortic valve disease

R S Trenouth, N C Phelps, W A Neill

    Circulation
    |April 1, 1976
    PubMed

    Insights

    Patients with aortic valve disease and left ventricular hypertrophy show normal resting myocardial oxygen supply but may produce lactate when the heart rate increases. Surgical outcomes correlate with myocardial mass and lactate production.

    Area of Science:

    • Cardiology
    • Cardiovascular Physiology

    Background:

    • Left ventricular hypertrophy (LVH) is a common adaptation to aortic valve disease.
    • Understanding myocardial oxygen (O2) supply and demand in LVH is crucial for patient management.

    Purpose of the Study:

    • To evaluate myocardial mass and O2 supply in patients with LVH due to aortic stenosis or insufficiency.
    • To correlate these parameters with left ventricular load and surgical outcomes.

    Main Methods:

    • Quantitative assessment of left ventricular mass using angiography, verified by autopsy.
    • Measurement of myocardial oxygen consumption, coronary blood flow, and ventricular tension.
    • Induction of tachycardia via atrial pacing to assess myocardial lactate production.

    Main Results:

    • Left ventricular mass, O2 consumption, and coronary blood flow correlated with left ventricular total load.
    • Ventricular tension was disproportionately higher in aortic stenosis compared to aortic insufficiency, potentially due to eccentric remodeling.
    • Resting myocardial O2 consumption and blood flow per gram were normal in hypertrophied ventricles.
    • Tachycardia induced lactate production in 50% of aortic stenosis patients, but none with aortic insufficiency.

    Conclusions:

    • Myocardial oxygen supply and demand are quantitatively related to ventricular load in LVH.
    • Aortic stenosis patients exhibit altered ventricular mechanics and are prone to myocardial ischemia during stress.
    • Myocardial mass and stress-induced lactate production are significant predictors of surgical mortality in this cohort.

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