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Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
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Hemodynamic patterns for symptomatic presentations of severe aortic stenosis
Sung-Ji Park1, Maurice Enriquez-Sarano, Sung-A Chang
1Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
JACC. Cardiovascular Imaging
|March 16, 2013
Summary
Severe aortic stenosis symptoms are linked to specific heart mechanics. Syncope relates to reduced heart output, while dyspnea indicates worsening diastolic dysfunction, guiding better AS assessment.
Area of Science:
- Cardiology
- Cardiac Physiology
- Echocardiography
Background:
- Severe aortic stenosis (AS) symptoms like syncope, dyspnea, and chest pain are critical indicators for aortic valve replacement.
- Patient survival is significantly influenced by the specific symptoms developed in severe AS.
- This study investigates the relationship between AS symptoms and intracardiac hemodynamics, including AS severity.
Purpose of the Study:
- To explore the unique intracardiac hemodynamic characteristics that lead to diverse clinical presentations in severe aortic stenosis (AS).
- To determine if specific symptom types in severe AS correlate with distinct hemodynamic profiles and disease severity.
Main Methods:
- Analysis of 498 patients with severe AS and normal left ventricular ejection fraction, assessed via comprehensive echocardiography.
- Classification of patients into four groups: asymptomatic, syncope, dyspnea, and chest pain.
- Comparison of echocardiographic measurements of cardiac structure, function, and intracardiac hemodynamics across the four groups.
Main Results:
- While AS severity (mean gradient, aortic valve area) was comparable across groups, symptomatic patients were older, had lower cardiac output, and higher E/e' ratios than asymptomatic individuals.
- Patients experiencing syncope (Group II) showed smaller left ventricular dimensions, stroke volume, cardiac output, left atrial volume index, and E/e' ratio.
- Patients with dyspnea (Group III) exhibited the most impaired diastolic function, characterized by the largest left atrial volume index and highest E/e' ratio.
Conclusions:
- In severe AS, symptoms are associated with specific hemodynamic patterns: syncope linked to a smaller left ventricle and reduced cardiac output, and dyspnea linked to advanced diastolic dysfunction.
- Comprehensive assessment of intracardiac hemodynamics, including diastolic function and stroke volume, is crucial alongside aortic valve area and pressure gradient for accurate AS evaluation.
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