Left ventricular torsional dynamics in symptomatic versus asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction

Introduction: In patients (pts) with severe aortic stenosis (AS) and normal left ventricular ejection fraction (LVEF) the occurrence of heart failure symptoms is related not only to AS severity, but also to a variety of other factors, including LV function. Although apical rotation and LV torsion are increased and LV untwisting is delayed in pts with severe AS, their role in the progression of AS to the symptomatic state is not clear yet. Purpose: To comparatively assess LV torsional deformation in asymptomatic versus symptomatic pts with a similar degree of AS and normal LVEF (> 50%). Methods: We studied 27 consecutive asymptomatic pts (63 ± 10 years, 17 men) and 27 age, gender and AS severity matched symptomatic pts (63 ± 13 years, 17 men), all with severe AS (indexed aortic valve area < 0.6 cm2 / m2 , 0.45 ± 0.09 and 0.44 ± 0.09 cm2 /m2 , respectively) and preserved LVEF, without coronary artery disease and no more than mild aortic or mitral regurgitation. A comprehensive echocardiogram was performed in all, including LV longitudinal and torsional deformation analysis by speckle tracking echocardiography. All symptomatic pts had exertional dyspnea (NYHA class 2 in 24 and class 3 in the remaining 3 pts), 12 pts had chest pain and one patient presented a syncope. Results: We found no signifi cant diff erences between asymptomatic and symptomatic pts regarding valvuloarterial impedance, LV relative wall thickness, indexed LV volumes and mass, LVEF, septal and lateral peak systolic myocardial velocities (p > 0.3 for all). Global longitudinal LV strain was not signifi cantly diff erent between groups (-15.6 ± 3.1 vs. -16.1 ± 3.2%, p = 0.5). Th e degree of LV diastolic dysfunction and E/E’ ratio were similar in both groups, although symptomatic pts tended to have larger left atria (13.9 ± 3.2 vs. 12.3 ± 2.4 cm2 /m2 , p = 0.05). Peak apical rotation was signifi cantly higher in asymptomatic vs symptomatic pts (25.4 ± 6.2 vs 21.9 ± 4.7°, p = 0.03). Peak basal rotation, LV torsion and untwisting parameters were all similar between groups (p > 0.4 for all). Conclusions: Left ventricular apical rotation is significantly higher in asymptomatic pts with severe AS compared to symptomatic pts with the same degree of valvular and global LV load, despite similar changes in LV geometry and function. This suggests a possible implication of a progressive loss of increased LV apical rotation in the transition to the symptomatic state in pts with severe AS.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)