Sequential study of left ventricular function in aortic valvular stenosis

Abstract

To assess the progression of aortic valvular gradients (AVG) and their relation to left ventricular function, 21 patients with aortic valvular stenosis were studied sequentially by cardiac catheterization and left ventriculography. All AVG were obtained from the left ventricle to ascending aortic pullback tracings. The ejection fraction and mean velocity of circumferential fiber shortening were obtained from left ventriculograms. A new onset of syncopal episode was helpful to predict the progression of AVG in five patients, but in others the progression of aortic stenosis was generally not predictable. The left ventricular contractility of these patients was usually normal, but seven patients exhibited the progressive impairment that was not proportional to the change of AVG and was clinically unrecognized. Also, the left ventricular function may deteriorate in the absence of progression of the aortic valvular gradient. Thus, serial hemodynamic studies could be indicated in patients with mild to moderate aortic stenosis even in the absence of new symptoms and signs.

ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary

“…As noted previously (see Section III-A-2), the natural history of mild AS is variable, with some patients manifesting a relatively rapid progression of AS with a decrease in valve area of up to 0.3 cm 2 per year and an increase in pressure gradient of up to 15 to 19 mm Hg per year; however, the majority may show little or no change (20,(22)(23)(24)(25)(26)37,(592)(593)(594)(595)(596)(597). The average rate of reduction in valve area is on average 0.12 cm 2 per year (20), but the rate of change in an individual patient is difficult to predict.…”