Left Ventricular Systolic Longitudinal Function, Afterload and Contractility in Severe Aortic Stenosis

pp. 319-325

Abstract

Background: In patients with severe aortic stenosis (AS), left ventricular systolic longitudinal function (SLF) is impaired despite preserved ejection fraction (EF). However, similarly to other shortening indexes, SLF depends on afterload and its relationship with contractility has not been thoroughly studied.

Objective: The aim of this study was to evaluate SLF alterations and their relationship with afterload and myocardial contractility in patients with severe AS.

Methods: One hundred and one patients with severe AS (AVA <1 cm2) and 63 normal control subjects were studied with Doppler echocardiography. Left ventricular systolic longitudinal function was evaluated by lateral mitral annulus systolic displacement (MASD) and peak S wave velocity (tissue Doppler imaging). Contractility was assessed by the midwall fractional shortening (mFS)– end-systolic stress (ESS) relationship in control subjects. Contractility level (CL) was defined as measured mFS minus predicted mFS for a defined ESS value.

Results: Lateral mitral annulus systolic displacement and S wave correlated directly with shortening indexes as EF and mFS and inversely with afterload indexes as ESS. There was no correlation between SLF and CL. In the multivariate analysis ESS and EF were predictors of SLF.

Conclusions: In patients with severe AS, SLF correlated inversely with afterload. The presence of decreased MASD or S wave was not associated with abnormal left ventricular contractility.