Abstract 13729: Significant Prognostic Values of Acute Preload Stress Echocardiography by Using Leg-positive Pressure Maneuver in Patients With Severe Aortic Stenosis
Introduction: Recently, leg-positive pressure (LPP) maneuver, using customized air-bags inflated both lower limbs to maintain a constant loading pressure (90 mmHg for 5 minutes), is reported to be able to apply acute preload stress non-invasively without significant change in either heart rate or blood pressure.
Hypothesis: We hypothesized the ability to utilize the Frank-Starling mechanism without significant increase in left ventricular (LV) filling pressure in response to LPP stress could provide additional prognostic capability for patients with aortic stenosis (AS).
Methods: We prospectively recruited 48 patients with severe AS. LV stroke volume (SV) was assessed by means of pulsed-wave Doppler, and then normalized by body surface area (SVi). The ratio of transmitral E wave and mitral annular velocity (e’) was calculated to estimate LV filling pressure. These parameters were obtained both at rest and during LPP stress. Event-free survival was then tracked for 136 days.
Results: Eight patients developed adverse cardiac events. During acute preload stress, forward SV increased significantly (SVi : 42±9 to 48±9 ml/m2, p<0.001) along with minimal change in LV filling pressure (E/e’: 20±8 to 21±11, n.s.) in patients without cardiac events. On the other hand, Frank-Starling mechanism was significantly impaired (SVi: from 41±10 to 38±8 ml/m2), while LV filling pressure increased to the critical level (E/e’:26±7 to 33±7, p<0.01) in patients with cardiac events. When the patients were divided into two subgroups based on the response to LPP stress, patients without preload reserve (ΔSVi<5ml/m2) showed worse event rate than the others (p<0.05). Similarly, patients without diastolic reserve (ΔE/e’ ratio >3) exhibited significantly worse event-free survival (p<0.05).
Conclusions: Assessment of preload reserve and diastolic reserve during LPP stress can enhance the predictive capability for cardiovascular outcomes events for patients with AS.
Author Disclosures: H. Matsuzoe: None. K. Matsumoto: None. H. Tanaka: None. H. Takada: None. F. Soga: None. Y. Hatani: None. K. Hatazawa: None. H. Shimoura: None. J. Ooka: None. H. Sano: None. K. Ryo-Koriyama: None. K. Hirata: None.
- © 2016 by American Heart Association, Inc.