engleski

The symmetry of the aortic outflow velocity profile in aortic stenosis: a novel predictor of functional improvement after aortic valve replacement?

LV outflow Doppler traces in severe aortic stenosis (AS) show higher, often prolonged velocities. Although the pressure gradient measured over a stenotic valve is indicative of stenosis severity, it often does not relate to myocardial function or changes in contractility resulting from myocardial damage. We hypothesize a relation between the shape of the profile of the aortic outflow velocity and myocardial function in AS. 35 patients undergoing aortic valve surgery for severe AS were studied by echocardiography pre- (PRE) and 1 year postoperatively (POST). 29 healthy volunteers served as controls. Ejection fraction (EF), aortic valve area (AVA) and mean aortic gradient (PG mean) were measured while semi &#8211; automated analysis was applied to aortic continuous wave (CW) velocity traces. The asymmetry of the velocity profile (asymm) was quantified as the normalized difference of area under the curve of left and right half of the spectrum so that a lower asymm corresponds to more symmetrical, later peaking flow. A significant correlation was found between asymm PRE and change in EF POST-PRE (r=0.66, P<0.05). No correlations were found between AVA nor PG mean and change in EF POST-PRE (r=0.05, r=0.04 ; P>0.05). Asymm PRE did not correlate significantly with PG mean PRE (r=0.18), while the patients with values of asymm PRE > 0.15 all showed improvement in EF POST-PRE, regardless of PG mean PRE. A symmetrical aortic outflow profile might reflect not only higher grade AS, but seems related to a reduction in LV function and predicts its recovery after surgery with higher confidence than preoperative mean gradient. Semi-automated analysis provides additional clinical information on the functional impact of AS.

aortic stenosis; doppler echocardiography; remodelling

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