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Left ventricular diastolic function in children and young adults with congenital aortic valve disease

Kevin G Friedman1, Doff B McElhinney, Jonathan Rhodes

  • 1Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA. Kevin.Friedman@cardio.chboston.org

The American Journal of Cardiology
|October 30, 2012
PubMed

Insights

Diastolic dysfunction is common in young patients with aortic stenosis and combined aortic valve disease, but not isolated aortic regurgitation. Increased left ventricular mass and prior aortic valve dilation are linked to this condition.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Echocardiography

Background:

  • Young patients with congenital aortic valve disease face risks of left ventricular (LV) diastolic dysfunction (DD).
  • Understanding LV remodeling and DD prevalence is crucial for managing these young patients.

Purpose of the Study:

  • To evaluate LV remodeling patterns.
  • To determine the prevalence and risk factors for DD in young patients with aortic stenosis (AS), pure aortic regurgitation (AR), and combined AS+AR.

Main Methods:

  • Cross-sectional assessment of LV remodeling and diastolic function in 246 patients (aged 8-39 years).
  • A diastolic function score (DFS) was assigned based on mitral inflow, tissue Doppler E', E/E', and left atrial volume.
  • Patients were categorized by DFS (≥2 vs. <2) for comparison.

Main Results:

  • Concentric hypertrophy was most common in AS, mixed in AS+AR, and eccentric in AR.
  • 37% of the cohort had a DFS of ≥2, indicating significant DD.
  • Patients with AS or AS+AR showed greater DFS than those with pure AR (p <0.001).
  • Higher LV mass z-score and prior aortic valve balloon dilation were associated with DFS ≥2.
  • Elevated LV end-diastolic pressure and mean pulmonary artery pressure were observed in patients with DFS ≥2.

Conclusions:

  • Diastolic dysfunction is prevalent in young patients with AS and AS+AR, but not in pure AR.
  • Increased LV mass and previous aortic valve dilation are significant risk factors for DD in this population.
  • These findings highlight the importance of monitoring diastolic function in young patients with specific congenital aortic valve conditions.

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