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Prognostic significance of late-peaking left ventricular velocity contour in patients with aortic stenosis undergoing
Insights
An abnormal late-peaking left ventricular velocity pattern in patients undergoing aortic valve replacement indicates a higher risk of postoperative complications, including arrhythmias and hypotension. Doppler echocardiography can identify these high-risk patients before surgery.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Surgery
Background:
- Abnormal late-peaking left ventricular velocity contours are associated with conditions like hypertrophic cardiomyopathy and aortic stenosis.
- Doppler echocardiography is a key diagnostic tool for identifying these velocity patterns.
Purpose of the Study:
- To investigate the clinical and prognostic significance of abnormal late-peaking left ventricular velocity contours.
- To determine if this Doppler finding predicts postoperative complications in patients with isolated aortic stenosis undergoing valve replacement.
Main Methods:
- Studied 57 patients with isolated aortic stenosis undergoing aortic valve replacement.
- Divided patients into two groups based on the presence or absence of a late-peaking ventricular velocity pattern.
- Analyzed preoperative, intraoperative, and postoperative data, including hemodynamic parameters and complication rates.
Main Results:
- Patients with abnormal contours had significantly higher rates of arrhythmias, hypotension, and need for inotropic support post-surgery.
- Hemodynamic differences included higher pulmonary diastolic pressure, wedge pressure, and systemic vascular resistance, with a lower cardiac index.
- No significant differences in age, sex, coronary artery disease, or peak preoperative aortic valve gradients were observed between groups.
Conclusions:
- An abnormal late-peaking ventricular velocity contour is a high-risk marker for postoperative complications in patients undergoing aortic valve replacement for aortic stenosis.
- Routine Doppler evaluation can identify patients at increased risk, allowing for targeted management.
Background:
The presence of an abnormal late-peaking left ventricular velocity contour, detected by Doppler echocardiography, has been reported in patients with hypertrophic cardiomyopathy, left ventricular hypertrophy, and aortic stenosis.
Methods And Results:
To evaluate the clinical and prognostic significance of this characteristic Doppler finding, we studied a group of patients (n = 57) with isolated AS undergoing aortic valve replacement. Patients were divided into two groups according to the presence (n = 28) or absence (n = 29) of a hypertrophic late-peaking left ventricular velocity pattern. There were no differences between the groups with respect to age, sex, and presence of coronary artery disease. Peak preoperative aortic valve gradients were similar in both groups (70 vs. 67 mm Hg; p = not significant). The postoperative course of patients with abnormal late-peaking ventricular velocity contour was complicated by a higher incidence of arrhythmias (80% vs. 38%; p = 0.0002). Hypotension and the use of inotropic support were significantly more common in the group with abnormal late-peaking ventricular velocity contour (79% vs. 24%; p = 0.0001 and 76% vs. 26%; p = 0.0001, respectively). Hemodynamically, patients with a late-peaking velocity pattern exhibited a higher pulmonary diastolic pressure (16+/-3 vs 12+/-2 mm Hg; p = 0.0003), wedge pressure (12+/-4 vs 10+/-2; p < 0.05), and systemic vascular resistance (2126+/-459 vs 1553+/-199; p = 0.0001) and lower cardiac index (2.4+/-0.3 vs 2.9+/-0.4; p = 0.0001).
Conclusions:
An abnormal late-peaking ventricular velocity contour pattern appears to be a high risk marker for postoperative complications in patients undergoing aortic valve replacement. Routine Doppler evaluation in patients undergoing valve replacement for AS may therefore identify these patients.