[Aortic stenosis with left ventricular systolic dysfunction: a severe disease but with good surgical prognosis]

From our series of 72 patients with severe valvular aortic stenosis, we identified 19 showing features of left ventricular systolic disfunction (ventriculographic ejection fraction less than 55% and/or fractional shortening less than 30% at M-mode echocardiography). In these patients, we found a significant inverse correlation between the fractional shortening and the systolic wall stress (r = 0.79, p less than 0.001). Clinically, 18 of the 19 patients were in NYHA class III (n = 11) or IV (n = 5), and two died before they could be operated upon. The remaining 17 had their aortic valve replaced (coronary artery bypass surgery was simultaneously performed in 2 patients). After a mean follow-up of 18 months, all patients are alive and show substantial symptomatic improvement (15 patients in class I and 2 patients in class II). Cardiothoracic index was reduced (61 +/- 5% preoperatively versus 52 +/- 5% postoperatively), and fractional shortening changed from 21 +/- 5% to 30 +/- 5%. The latter remains under normal limits in two thirds of the patients. Our results lend support to the idea that the systolic left ventricular dysfunction in aortic stenosis is due to the increased afterload, rather than to an intrinsic contractility defect. This explains the great functional improvement after the reduction of the systolic wall stress achieved by surgery.