Left ventricular filling patterns in aortic stenosis in patients older than 65 years of age

Gallino, Robert; Milner, Mark R.; Goldstein, Steven Allen; Pichard, Augusto D.; Majchrzak, Camille; Lindsay, Joseph

doi:10.1016/0002-9149(89)90086-6

Cited by 11 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, DT is an early to mid‐diastolic measurement, whereas the LVEDP is a late diastolic measurement. The results of the present study differ from those of Gallino et al, 10 who found the E/A ratio to be a closer correlate of LV mean diastolic pressure ( r =0.72) than was DT ( r =0.35) in 26 patients with AS. Vanoverschelde et al 11 found a strong curvilinear correlation between E/A and PCWP ( r =0.96) in patients with AS, but also did not evaluate DT.…”

Section: Discussioncontrasting

confidence: 99%

See 1 more Smart Citation

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

D'Agate

Smith

Lazar

2002

American J Geri Cardiology

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 99%

“…The studies were small and the patient population in the present study was larger than that of either of the two prior studies. Although additional studies have evaluated Doppler LV diastolic filling in AS with Doppler echocardiography, 10–13 they did not include the specific hemodynamic and Doppler parameters used in this study.…”

Section: Discussionmentioning

confidence: 99%

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

D'Agate

Smith

Lazar

2002

American J Geri Cardiology

View full text Add to dashboard Cite

show abstract

“…4); these data indicate a direct relationship between the severity of cardiac dys function and indices of left atrial hypertension. Further more, the severity of the clinical picture of congestive heart failure appears to be related both to indices of sys tolic LV performance and filling, as demonstrated pre viously [47,49] and in the present study.…”

Section: V Filling In Aortic Stenosissupporting

confidence: 73%

“…Particularly Doppler échocardiographie study of transmitral flow, val idated by hemodynamic data obtained during cardiac catheterization, allowed to characterize the different pat terns of LV filling in patients with chronic pressure over load due to aortic stenosis [46][47][48][49], Thus, it has been dem onstrated that mean left atrial pressure is the main deter minant of early filling and that Doppler transmitral flow indices of early filling, such as peak E velocity, decelera tion time of E wave and E/A ratio, strongly correlate with mean pulmonary capillary wedge pressure [49]. Ventricu lar relaxation also determines, opposite to left atrial pres sure, the pattern of early filling.…”

Section: V Filling In Aortic Stenosismentioning

confidence: 99%

Congestive Heart Failure in Patients with Valvular Aortic Stenosis

Faggiano¹,

Rusconi²,

Sabatini³

et al. 1995

Cardiology

View full text Add to dashboard Cite

The aim of this study was to evaluate echographically anatomic and functional features of the left ventricle in adult patients with valvular aortic stenosis according to the presence or absence of congestive heart failure and the level of ventricular performance. Fifty-six adult patients with moderate-to-severe aortic stenosis underwent echocardiographic Doppler examination in order to evaluate left ventricular mass and dimensions, systolic function and filling dynamics. Twenty-seven patients had no heart failure and were symptomatic for angina (5), syncope (4) or were symptom-free (group I); the other 29 had heart failure (group II): 16 with normal left ventricular systolic performance (fractional shortening > 25%, group IIa) and 13 with systolic dysfunction (fractional shortening ≤ 25%, group IIb). Despite a similar left ventricular mass, compared to group IIa, group IIb showed a significant left ventricular dilatation (end-diastolic diameter: 61 ± 6.5 vs. 45.5 ± 6.1 mm, p < 0.001) and mild or no increase in wall thickness (11.5 ± 1.6 vs. 14.9 ± 2 mm, p < 0.001). Indices of left ventricular filling on Doppler transmitral flow were also significantly different between the two groups, with a higher early-to-late filling ratio and a shorter deceleration time of early filling in group IIb (2.8 ± 1.9 vs. 1.2 ± 0.85, p < 0.01, and 122 ± 66 vs. 190 ± 87 ms, p < 0.05, respectively), both indirectly indicating higher left atrial pressure. Finally, heart failure was generally more severe in group IIb patients. In some patients with aortic stenosis, symptoms of heart failure may be present despite a normal left ventricular systolic function and seem to depend on abnormalities of diastolic function. The presence of systolic or isolated diastolic dysfunction appears to be related to a different geometric adaptation of the left ventricle to chronic pressure overload.

show abstract

“…Indices of diastolic filling included the peak early filling wave (E wave), the peak filling wave with atrial systole (A wave), the ratio of the peak A to the peak E wave (A/E ratio), the rate of deceleration of the E wave (EF slope) and the deceleration time (DT) of the E wave. Baseline and peak exercise ejection fractions were calculated using Simpson's biplane method [2], Quantitative analyses were per formed using an off-line échocardiographie computer system (Nova Micro System) by previously described methods [3].The patient's blood pressure rose from a baseline of 200/100 to 240/120 at peak exercise and returned to 180/90 by the 5th min of recovery. Figure 1 illustrates the Doppler-derived left ventricular fill ing patterns from the study period.…”

mentioning

confidence: 99%

Left Ventricular Filling Patterns in Hypertensive Pulmonary Edema

Gallino¹,

Milner²,

Blunda³

et al. 1992

Am J Noninvas Cardiol

Self Cite

View full text Add to dashboard Cite

We report a case of congestive heart failure in a hypertensive subject with concentric left ventricular hypertrophy. Doppler analysis of left ventricular filling patterns revealed a decrease in active atrial filling (A wave) during exercise, not present in a comparison assymptomatic hypertensive patient. A drop in the A wave and the A/E ratio during exercise may serve as a marker for congestive heart failure related to diastolic dysfunction.

show abstract

Left ventricular filling patterns in aortic stenosis in patients older than 65 years of age

Cited by 11 publications

References 20 publications

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

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

Congestive Heart Failure in Patients with Valvular Aortic Stenosis

Left Ventricular Filling Patterns in Hypertensive Pulmonary Edema

Contact Info

Product

Resources

About