Doppler Echocardiographic Assessment of Left Ventricular Filling Pressures in Elderly Patients With Moderate/Severe Aortic Stenosis

Abstract

Doppler-derived mitral inflow indices reflect left ventricular (LV) filling pressures but often vary with age. Diastolic filling is impaired in LV pressure overload states. The objective of this study was to determine the influence of age on the relationship between mitral inflow indices and LV filling pressures in patients with aortic stenosis. The authors studied 57 consecutive patients (age, 77 years; 52% male) with moderate to severe aortic stenosis (aortic valve area < or =1.0 cm(2)) on cardiac catheterization and echocardiographic studies performed within 48 hours of catheterization. Patients with atrial fibrillation, aortic insufficiency, mitral stenosis, and paced rhythm were excluded. Echocardiographic variables obtained from five cardiac cycles were: E/A ratio and deceleration time (DT). Patients were subclassified by age (< and > or =75 years), ejection fraction ([EF] < and > or =50%), and coronary artery disease (CAD). Pulmonary capillary wedge pressure (PCWP) correlated with DT (r=-0.86; p=0.001) and with E/A (r=0.7; p=0.001) more strongly than did LV end-diastolic pressure. Age did not alter the relationship between DT and PCWP (r=-0.92; p=0.001 for < 75 years vs. r=-0.83; p=0.001 for > or =75 years). PCWP was predicted by the equation PCWP=-0.10DT+43, regardless of age. EF also had little influence on the correlation between PCWP and DT (r=-0.80; p=0.001 for EF < 50% vs. r=-0.94; p=0.001 for EF > or =50%). Similarly, there were no significant differences between the regression equations and correlations between the CAD and no-CAD groups: for CAD patients, PCWP=41.8-0.10DT; p < 0.0001; r=-0.84 (p < 0.0001). For no-CAD subjects, PCWP=46.2-0.12DT; p < 0.0001; r=20.92 (p < 0.0001). In patients with significant aortic stenosis, DT correlated strongly with PCWP but not with LV end-diastolic pressure. This relationship was independent of age, CAD, or EF.

Age‐Related Changes in Hemodynamics Affecting Valve Performance

“…The coexistence of aortic stenosis can also affect measures of diastolic filling. 60 These findings demonstrate the complex way in which the system as a whole can affect transvalvular flow. After mitral valve prolapse, ischemic mitral regurgitation is the next most common etiology in patients undergoing surgical intervention.…”