Abstract 12540: The Relation between Left Ventricular Diastolic Function and Left Ventricular Hypertrophy (LVH) in Patients with Severe Isolated Aortic Stenosis (AS) and Preserved Left Ventricular Ejection Fraction (EF)
Objective: LV diastolic dysfunction is the main pathophysiologic substrate of heart failure symptoms in severe AS with preserved EF and is associated with LVH. However LVH, is absent in many pts with symptomatic severe AS. We hypothesized that abnormal diastolic function is present in symptomatic AS even in the absence of LVH.
Methods: Of 533 pts (97% symptomatic) with echocardiographic findings of severe isolated AS , preserved EF, and normal sinus rhythm , 292 had no mitral annular calcification of whom 78 (27%) were prospectively enrolled. LV mass was calculated by the ASE method with thresholds of 95 g/m2 and 115g/m2 for women and men respectively. Normal controls (n= 79) matched for age and gender were compared to AS groups (with and without LVH). Mean follow-up, 35.4 ± 31.6 months. Unadjusted univariate results were reanalyzed including the covariates, age ,sex, systolic blood pressure and diabetes, the variables which differed between the two groups. Pearson correlations were calculated to examine the linear relationships of continuous LV mass index with the variables reported below.
Results: (see table) A univariate difference in E/E’m between AS with and without LVH was abolished by controlling for covariates while differences in left atrial diameter (LAD) and volume index were unaffected. LAD, LA volume index , E/A and E/E’ at medial corner of mitral annulus (m) had significantly higher values in both AS groups than controls (p < 0.0001 for each.) There were weak correlations between LV mass index and LAD, volume index and E/E’m :0.34 (p <0.0001), 0.27 ( p=0.009) and 0.19 ( p = 0.002), respectively), and between relative wall thickness and deceleration time of E wave (r = 0.14, p = 0.01.
Conclusions: 1. Elderly AS patients with and without LVH have abnormal LV diastolic function. 2. In adjusted models, AS pts with LVH have larger LA size than those without LVH but Doppler parameters of diastolic function, including E/E’m, do not differ between the two groups.
- © 2012 by American Heart Association, Inc.