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Dynamic left ventricular dyssynchrony: a potential cause of no contractile reserve in patients with low-gradient

Patrizio Lancellotti1, Catherine Szymanski, Marie Moonen

  • 1Department of Cardiology, University Hospital of Liège, Liège B-4000, Belgium. plancellotti@chu.ulg.ac.be

European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology
|June 11, 2009
PubMed

Insights

Dobutamine stress echocardiography revealed increased left ventricular (LV) dyssynchrony in a patient with low-gradient aortic stenosis (AS). This dyssynchrony, alongside ischemic cardiomyopathy, impacted stroke volume response.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Heart Failure

Background:

  • Low-gradient aortic stenosis (AS) poses challenges in risk stratification.
  • The role of left ventricular (LV) dyssynchrony in AS is not well understood.
  • Dobutamine stress echocardiography (DSE) is a key tool for assessing AS severity and cardiac function.

Observation:

  • A case study of a patient presenting with AS and significant LV dyssynchrony.
  • DSE demonstrated a lack of contractile reserve.
  • An increase in LV dyssynchrony was observed during DSE.

Findings:

  • Reduced aortic valve area was attributed to severe AS and inadequate forward stroke volume from ischemic cardiomyopathy.
  • LV dysfunction was likely multifactorial, including intrinsic myocardial dysfunction and afterload mismatch.
  • Dynamic LV dyssynchrony emerged as a potential determinant of forward stroke volume response.

Implications:

  • This case highlights the importance of evaluating LV dyssynchrony in patients with low-gradient AS.
  • Understanding dyssynchrony may refine prognostic assessments and treatment strategies for AS.
  • Further research is warranted to explore the interplay between AS, LV dyssynchrony, and ischemic cardiomyopathy.

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