Elsevier

American Heart Journal

Volume 148, Issue 4, October 2004, Pages 696-702
American Heart Journal

Tissue Doppler imaging in patients with moderate to severe aortic valve stenosis: Clinical usefulness and diagnostic accuracy

https://doi.org/10.1016/j.ahj.2004.03.049Get rights and content

Abstract

Background

Mitral annular velocities derived from tissue Doppler imaging (TDI) provide information about left ventricular (LV) long-axis function and allow for the assessment of LV filling pressures in selected subsets of patients. It was the aim of this study to assess the usefulness of TDI in patients with moderate to severe aortic valve stenosis (AS).

Methods

Twenty-three patients with moderate to severe AS (mean aortic valve area 0.8 ± 0.4 cm2), in whom coronary artery disease had been ruled out, and 36 asymptomatic age-matched control subjects underwent assessment of ejection fraction, fractional shortening, and mitral inflow (E, A, E/A ratio). TDI velocities (S', E', A') were derived from the septal mitral annulus. In patients with AS, LV pressure before atrial contraction (LV pre-A pressure), LV end-diastolic pressure, and cardiac index were measured during cardiac catheterization.

Results

In patients with AS, systolic (S') and early diastolic mitral annular velocities (E') were significantly reduced in comparison to control subjects (systolic, 5.5 ± 1.2 vs 8.3 ± 1.3 cm/s; early diastolic, 5.6 ± 1.6 vs 10.2 ± 3.0 cm/s, P < .001 for both comparisons), but ejection fraction, fractional shortening, and cardiac index were normal. In patients with AS, LV pre-A pressures (14 ± 4 mm Hg) and end-diastolic pressures were high (19 ± 7 mm Hg). In such patients, the mitral E/E' ratio was significantly related to LV pre-A pressure (r = 0.75, P < .001) and to LV end-diastolic pressure (r = 0.78, P < .001). In patients with AS, an E/E' ratio ≥13 identified an LV end-diastolic pressure >15 mm Hg, with a sensitivity of 93% and a specificity of 88%.

Conclusions

In patients with moderate to severe AS, TDI allows for a reliable, noninvasive estimation of filling pressures. In such patients, systolic long-axis function is impaired even in the presence of normal ejection fraction and cardiac index. Thus, TDI integrates information about systolic and diastolic performance and may be a useful addition in the echocardiographic workup and care of patients with AS.

Section snippets

Study population

To address these objectives, study participants were selected from 51 patients with moderate (aortic valve area > 1.0 to 1.5 cm2) or severe AS (area < 1.0 cm2)12 undergoing clinically indicated left and right heart catheterization in our institution (Hospital of the University of Münster).

Subjects with atrial fibrillation (n = 6), single- or dual-chamber pacemaker (n = 3), left bundle branch block (n = 4), mitral stenosis or regurgitation ≥2° (n = 4), aortic valve regurgitation ≥2° (n = 5),

Clinical data

Patient demographics are given in Table I.The two study groups and the control group did not differ significantly with respect to age, heart rate, body surface area, and systolic or diastolic blood pressure. In patients with AS, the mean valve area was 0.8 ± 0.4 cm2. In 6 patients, stenosis was moderate (valve area, 1.2 ± 0.2 cm2); in 17 patients, stenosis was severe (area, 0.6 ± 0.4 cm2). Four of 23 patients with AS (17%) had a bicuspid valve. In 19 patients with AS (83%), signs or symptoms

Discussion

Our study is the first to study the usefulness of the mitral E/E' ratio as an estimate of LV filling pressures in patients with AS and to validate it against invasive measurements derived from cardiac catheterization. The main finding is that the E/E' ratio allows for a readily derived, reliable, and reproducible estimation of LV filling pressures in patients with AS with mild to moderate stenosis. Furthermore, in our study, TDI provided evidence for impaired systolic long-axis function in

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