Evaluation of the Effect of Aortic Stenosis and Severity on Left Ventricular Function by Isovolumic Myocardial Acceleration

Abstract

Aim: Tissue Doppler-derived isovolumic acceleration (IVA) is a parameter that evaluates the systolic function of both ventricles, without being affected by pre-load and post-load. We aimed to detect left ventricular systolic dysfunction at an early stage with IVA in patients with asymptomatic aortic stenosis (AS). Material and Methods: A total of 105 patients were included in the study, 75 of which had isolated AS and 30 were free of any valve disease. Patients with AS were divided into three groups (mild, moderate and severe) according to their aortic valve area (AVA) and aortic peak velocities, as determined by means of a transthoracic echocardiography. Conventional echocardiography, systolic and diastolic Tissue Doppler parameters [peak myocardial velocity during isovolumic contraction (IVV), myocardial velocity during ejection phase (Sm), early diastolic myocardial velocity (e'), late diastolic myocardial velocity (a'), and acceleration time (AT)] were calculated in all patients. IVA was obtained by dividing the IVV flow rate by the AT time. Results: The systolic parameters IVV (p<0.001), Sm (p<0.001), IVA (p=0.002) and diastolic parameters e' wave (p<0.001), a' wave (p=0.001) were found to be significantly lower in patients with AS compared to the control group. However, this relationship observed in IVA was not different in AS subgroups (p=0.122). Sm and e' waves were positively correlated with AVA (p=0.001, p<0.001, respectively) and negatively correlated with aortic peak gradient (p=0.008, p<0.001, respectively), but IVA was not correlated. Conclusion: Left ventricular function is impaired in patients with AS and this is independent of the severity of AS.

Keywords

• aortic stenosis
• isovolumic acceleration
• tissue Doppler imaging

Aort Darlığı ve Ciddiyetinin Sol Ventrikül Fonksiyonuna Etkisinin İsovolumik Miyokardiyal Akselerasyon ile Değerlendirilmesi

Abstract

Amaç: Doku Doppler kaynaklı isovolumik akselerasyon (İVA) her iki ventrikülün sistolik fonksiyonunu ön ve ard yükten etkilenmeden değerlendiren bir parametredir. Bu çalışmada asemptomatik aort darlığı (AD) olan hastalarda, sol ventrikül sistolik disfonksiyonun İVA ile erken aşamada tespiti amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya izole AD bulunan 75 hasta ve herhangi bir kapak hastalığı bulunmayan 30 hasta olmak üzere toplam 105 hasta dahil edildi. AD hastaları, transtorasik ekokardiyografi ile belirlenen aort kapak alanı (AKA) ve aortik pik velositeye göre üç gruba (hafif, orta ve ileri) ayrıldı. Konvansiyonel ekokardiyografi parametreleri, sistolik ve diyastolik doku Doppler parametreleri [isovolumik kontraksiyon esnasında oluşan pik miyokardiyal velosite (IVV), ejeksiyon fazında oluşan miyokardiyal velosite (Sm), erken diyastolik miyokardiyal velosite (e'), geç diyastolik miyokardiyal velosite (a'), akselarasyon zamanı (AT)] tüm hastalarda hesaplandı. İVA, IVV akım hızının AT süresine bölünmesiyle elde edildi. Bulgular: Sistolik parametrelerden IVV (p<0.001), Sm (p<0.001), İVA (p=0.002) ve diyastolik parametrelerden e' dalgası (p<0.001), a' dalgası (p=0.001) AD bulunan hastalarda kontrol grubuna göre anlamlı şekilde düşük izlendi. Fakat İVA da izlenen bu ilişki AD alt gruplarında anlamlı değildi (p=0.122). Sm ve e' dalgasının, AKA ile pozitif yönde (sırasıyla p=0.001, p<0.001) aortik pik gradiyentle negatif yönde korelasyonu vardı (sırayla p=0.008, p<0.001), ancak İVA ise korele değildi. Sonuç: AD olan kişilerde sol ventrikül fonksiyonu bozulmuştur ve bu AD ciddiyetinden bağımsızdır.

Keywords

• aort darlığı
• isovolumik akselerasyon
• doku Doppler görüntüleme

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