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Congestive heart failure in patients with valvular aortic stenosis. A clinical and echocardiographic Doppler study
P Faggiano1, C Rusconi, T Sabatini
1Divisione di Cardiologia, Ospedale S. Orsola-Fatebenefratelli, Brescia, Italia.
Insights
In patients with aortic stenosis, heart failure can occur with normal systolic function, linked to diastolic dysfunction. This suggests different left ventricular adaptations to pressure overload.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Valvular aortic stenosis (AS) is a significant cardiovascular condition.
- Left ventricular (LV) remodeling and dysfunction are common in AS.
- The relationship between heart failure (HF), LV performance, and diastolic function in AS requires further elucidation.
Purpose of the Study:
- To investigate the echocardiographic features of the LV in adult patients with moderate-to-severe AS.
- To correlate these features with the presence of congestive heart failure (CHF) and the level of LV performance.
- To understand the role of diastolic dysfunction in AS-related heart failure.
Main Methods:
- Echocardiographic Doppler examination was performed on 56 adult patients with moderate-to-severe AS.
- Evaluated parameters included LV mass, dimensions, systolic function (fractional shortening), and filling dynamics (Doppler transmitral flow).
- Patients were categorized into groups based on the absence (Group I) or presence of HF (Group II), with further subdivision of Group II based on LV systolic performance (IIa: normal, IIb: dysfunction).
Main Results:
- Despite similar LV mass, patients with HF and systolic dysfunction (Group IIb) exhibited significant LV dilatation and less wall thickening compared to those with normal systolic function (Group IIa).
- Doppler transmitral flow indices indicated higher left atrial pressure in Group IIb, with a higher early-to-late filling ratio and shorter deceleration time.
- Heart failure severity was generally greater in patients with systolic dysfunction (Group IIb).
Conclusions:
- Heart failure symptoms in some patients with AS can occur despite preserved LV systolic function, suggesting a primary role for diastolic dysfunction.
- Systolic or isolated diastolic dysfunction in AS may be associated with distinct patterns of LV geometric adaptation to chronic pressure overload.
- Echocardiography is crucial for assessing LV structure, function, and filling dynamics in AS patients, aiding in understanding HF development.
Abstract:
The aim of this study was to evaluate echographically anatomic and functional features of the left ventricle in adult patients with valvular aortic stenosis according to the presence or absence of congestive heart failure and the level of ventricular performance. Fifty-six adult patients with moderate-to-severe aortic stenosis underwent echocardiographic Doppler examination in order to evaluate left ventricular mass and dimensions, systolic function and filling dynamics. Twenty-seven patients had no heart failure and were symptomatic for angina (5), syncope (4) or were symptom-free (group I); the other 29 had heart failure (group II): 16 with normal left ventricular systolic performance (fractional shortening > 25%, group IIa) and 13 with systolic dysfunction (fractional shortening < or = 25%, group IIb). Despite a similar left ventricular mass, compared to group IIa, group IIb showed a significant left ventricular dilatation (end-diastolic diameter: 61 +/- 6.5 vs. 45.5 +/- 6.1 mm, p < 0.001) and mild or no increase in wall thickness (11.5 +/- 1.6 vs. 14.9 +/- 2 mm, p < 0.001). Indices of left ventricular filling on Doppler transmitral flow were also significantly different between the two groups, with a higher early-to-late filling ratio and a shorter deceleration time of early filling in group IIb (2.8 +/- 1.9 vs. 1.2 +/- 0.85, p < 0.01, and 122 +/- 66 vs. 190 +/- 87 ms, p < 0.05, respectively), both indirectly indicating higher left atrial pressure. Finally, heart failure was generally more severe in group IIb patients. In some patients with aortic stenosis, symptoms of heart failure may be present despite a normal left ventricular systolic function and seem to depend on abnormalities of diastolic function. The presence of systolic or isolated diastolic dysfunction appears to be related to a different geometric adaptation of the left ventricle to chronic pressure overload.