Left ventricular diastolic function is associated with symptom status in severe aortic valve stenosis

Area of Science:

• Cardiology
• Echocardiography
• Heart Failure

Background:

• Aortic stenosis (AS) symptoms may not align with valve severity or left ventricular (LV) function.
• Investigating differences in cardiac function between symptomatic and asymptomatic AS patients is crucial.

Purpose of the Study:

• To test the hypothesis that symptomatic AS patients exhibit impaired diastolic function, longitudinal systolic function, and left atrial enlargement compared to asymptomatic patients.
• To identify predictors of symptomatic status in severe AS.

Main Methods:

• Retrospective analysis of 99 symptomatic and 139 asymptomatic patients with severe AS and preserved LV ejection fraction (≥50%).
• Comparison of clinical characteristics and echocardiographic parameters.
• Logistic regression analysis to identify independent predictors of symptomatic state.

Main Results:

• Symptomatic patients were younger and had lower prevalence of atrial fibrillation, COPD, and hypertension.
• Despite similar AS severity, symptomatic patients showed higher LV mass index, increased relative wall thickness, shorter mitral deceleration time, and increased left atrial volume index.
• LV mass index, relative wall thickness, left atrial volume index, and deceleration time remained associated with symptoms after multivariable adjustment.

Conclusions:

• Symptomatic status in severe AS is linked to impaired diastolic function, LV hypertrophy, concentric remodeling, and left atrial dilatation.
• These cardiac changes are present even when corrected for AS severity.
• Echocardiographic findings can help differentiate symptomatic from asymptomatic severe AS patients.