Journal of the American Society of Echocardiography
Original articleAcute Improvement in Myocardial Function Assessed by Myocardial Strain and Strain Rate After Aortic Valve Replacement for Aortic Stenosis
Section snippets
Patients
We studied 55 consecutive patients with isolated moderate to severe AS (peak aortic velocity ≥ 3.0 m/s) referred to our institution. Patients with renal insufficiency with plasma creatinine level greater than 1.5 mg/dL, old myocardial infarction, more than mild mitral valve disease or aortic regurgitation, severe pulmonary disease, and segmental LV asynergy were excluded, leaving 34 patients (21 women, mean age 69.2 ± 10.4 years) for the study population. Medication included digitalis (n = 2),
Patient Characteristics
Characteristics for all 34 patients are shown in Table 1. Although LV systolic function was mostly preserved with a mean EF of 58.8%, 3 patients had decreased LV EF (<45%). Clinical and standard echocardiographic parameters before and after AVR are shown in Table 2. Average New York Heart Association class improved from 2.3 ± 0.6 to 1.2 ± 0.5 (P < .001). Heart rate significantly increased 2 weeks after AVR. LV size, wall thickness, and LVMI tended to decrease, but did not reach statistical
Preclinical LV Dysfunction in Patients with AS
In AS, the significant pressure overload increases LV systolic wall stress, which acts as a stimulus for hypertrophy of myocytes. Thus, we usually observe severe LV hypertrophy in patients with advanced AS. Although most of them have good LV EF even with significant LV hypertrophy, there has been myocardial dysfunction through reactive fibrosis.9 Moreover, LV diastolic function has been commonly impaired in the hypertrophied ventricle. Increased myocardial stiffness produces elevation of LV
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Supported in part by a research grant from the Ministry of Health, Labor, and Welfare, Japan.