Long axis excursion in aortic stenosis

Abstract

Objectives-To examine long axis excursion in patients with all grades of aortic stenosis and preserved transverse systolic function, and to compare long axis excursion in symptomatic with that in asymptomatic severe aortic stenosis. Design-Prospective comparative study. Setting-Regional cardiothoracic centre. Patients-78 patients with all grades of aortic stenosis and normal fractional shortening and ejection fraction were studied. There were two comparison groups, 10 age matched normal subjects and 14 patients with aortic stenosis and fractional shortening < 26%. Methods-Aortic valve function and left ventricular mass were assessed echocardiographically. M mode measurements of long axis excursion at the septal and lateral sides of the mitral annulus were taken. Results-There were significant diVerences between the groups in long axis excursion at both the septal (p < 0.0001) and lateral sides of the mitral annulus (p = 0.002 by analysis of variance). Long axis excursion was independently related to both left ventricular mass index (p = 0.001) and the grade of aortic stenosis (p = 0.002). Comparing patients with severe aortic stenosis with and without symptoms, there were significant diVerences in eVective orifice area (p = 0.02 ) and long axis excursion at the lateral side of the mitral annulus (p = 0.04), but not in fractional shortening, ejection fraction, or peak or mean pressure diVerence. Conclusion-In patients with aortic stenosis, long axis excursion is reduced even in the presence of normal fractional shortening or ejection fraction. It is lower in patients with symptomatic compared with asymptomatic severe aortic stenosis and may be of use in predicting the onset of symptoms. (Heart 2001;86:52-56)

Severe aortic stenosis with preserved ejection fraction and evidence of impairment in structure, myocardial strain and ventricular function: A new contribution to clinical decision making

“…This myocardial impairment and structural changes initially and mainly involve the subendocardium [40], affecting longitudinal function, which is not well assessed by EF, but can be assessed by other indices that use M-mode and/or tissue Doppler imaging to analyze the lateral displacement of the mitral annulus [41].…”

Association of Myocardial Deformation With Outcome in Asymptomatic Aortic Stenosis With Normal Ejection Fraction

“…29 Previous studies have shown longitudinal function to be an important marker of myocardial function in patients with severe AS and normal LVEF. [30][31][32] LV longitudinal shortening is more closely associated than ejection fraction with changes in symptom status, and may closely reflect alterations in subendocardial myocardial function. 31 Despite the absence of symptoms and a normal LVEF, patients with severe AS have an increased Zva.…”

Clinical Challenges in Accurate Assessment of Severe Aortic Stenosis With a Special Focus on Low-Gradient Aortic Stenosis and Normal Ejection Fraction

“…12, 16 Aurigemma et al compared hypertensive patients with LV hypertrophy and clinically normal patients, and demonstrated that high relative wall thickness allows for a normal EF despite depressed shortening at the midwall and along the long axis. 25 Takeda et al studied patients with AS and normal EF and found that the long axis excursion was lower in the AS population compared with normal individuals 26 ; moreover, short axis excursion was independently related to the grade of AS, being worse in patients with symptomatic disease. 26 In a recent study comparing the impact of myocardial fibrosis in patients with symptomatic severe AS, the longitudinal systolic function correlated with the degree of myocardial fibrosis and, moreover, predicted functional improvement after AVR.…”

“…25 Takeda et al studied patients with AS and normal EF and found that the long axis excursion was lower in the AS population compared with normal individuals 26 ; moreover, short axis excursion was independently related to the grade of AS, being worse in patients with symptomatic disease. 26 In a recent study comparing the impact of myocardial fibrosis in patients with symptomatic severe AS, the longitudinal systolic function correlated with the degree of myocardial fibrosis and, moreover, predicted functional improvement after AVR. 20 Interestingly, in this study, severe fibrosis was found in patients with normal EF, and EF was not predictive of better outcome after AVR.…”