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Updated: Jun 12, 2026
Echocardiographic Assessment of Cardiac Anatomy and Function in Adult Rats
Published on: December 13, 2019
Left ventricular systolic and diastolic function assessed by tissue Doppler imaging and outcome in asymptomatic
Ralph A H Stewart1, Andrew J Kerr, Gillian A Whalley
1Green Lane Cardiovascular Research, Auckland City Hospital, Auckland, New Zealand. RStewart@adhb.govt.nz
Insights
In severe aortic stenosis (AS) with normal ejection fraction, stenosis severity is key for predicting symptomatic decline. Left ventricular hypertrophy and diastolic function measures offer limited prognostic value beyond stenosis severity.
Area of Science:
- Cardiology
- Echocardiography
- Valvular Heart Disease
Background:
- Left ventricular (LV) hypertrophy and diastolic dysfunction are common in severe aortic stenosis (AS).
- The prognostic significance of these findings in asymptomatic patients with AS is uncertain.
Purpose of the Study:
- To assess if LV systolic/diastolic function or LV hypertrophy predict outcomes in asymptomatic severe AS patients.
- To determine the utility of tissue Doppler measures and echocardiographic LV hypertrophy for risk stratification.
Main Methods:
- 183 asymptomatic severe AS patients with normal LV ejection fraction were followed.
- Echocardiography measured peak systolic (S') and diastolic (E') mitral annular velocities, and LV mass.
- Patients were monitored for symptomatic deterioration over a median of 31 months.
Main Results:
- 58% of patients experienced symptomatic deterioration, including sudden death/cardiac arrest.
- Peak aortic velocity and aortic valve area were the strongest predictors of deterioration.
- LV mass index and LV systolic/diastolic function measures did not predict deterioration after adjusting for stenosis severity.
Conclusions:
- Stenosis severity is the primary predictor of symptomatic deterioration in severe AS with preserved LV ejection fraction.
- Tissue Doppler measures of LV function and LV mass provide minimal additional prognostic information.
- Risk stratification should focus on the degree of aortic stenosis.
Aims:
Left ventricular (LV) hypertrophy and abnormal non-invasive measures of LV diastolic function are common in patients with severe aortic stenosis (AS) but their prognostic importance is uncertain. This study aimed to determine whether tissue Doppler measures of LV systolic and/or diastolic function or echocardiographic LV hypertrophy are useful for risk stratifying asymptomatic patients with severe calcific AS.
Methods And Results:
One hundred and eighty-three initially asymptomatic patients with moderate or severe AS (valve area mean 0.96 ± SD 0.3 cm(2)) and a normal LV ejection fraction were followed for median 31 (IQR 14-40) months. Peak systolic (S') and diastolic (E') mitral annular velocities and LV mass were measured by echocardiography at baseline and during follow-up. During follow-up 106 (58%) patients suffered symptomatic deterioration, including three sudden deaths and one resuscitated cardiac arrest. Peak aortic velocity (for 0.5 m/s increase HR = 1.43, 95% CI 1.25, 1.64, P < 0.0001) and aortic valve area (-0.1 cm(2)/m(2) HR = 1.23, 95% CI 1.12, 1.35, P = 0.004) at baseline were most strongly associated with symptomatic deterioration. After peak aortic velocity adjustment neither LV mass index nor any measure of LV systolic or diastolic function was associated with symptomatic deterioration (P > 0.2 for all).
Conclusion:
In patients with calcific AS who have a normal LV ejection fraction the severity of stenosis is the most important correlate of symptomatic deterioration. Tissue Doppler measures of LV systolic and diastolic function and LV mass provide limited predictive information after accounting for the severity of stenosis.
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