Recovery of Long-Axis Left Ventricular Function after Aortic Valve Replacement in Patients with Severe Aortic Stenosis

Background: Patients with aortic stenosis (AS) should undergo aortic valve replacement (AVR) before irreversible LV dysfunction has developed. Assessment of long-axis left ventricular (LV) function may assist in proper timing of AVR. Objectives: To assess serial changes in long-axis LV function before and after AVR in patients with severe AS and preserved LV ejection fraction. Methods: The study comprised 27 consecutive patients (mean age 64.9 +/- 11.7 years, 15 males) with symptomatic severe AS, scheduled for AVR. Seventeen subjects without known cardiac disease, matched for age, gender, LV ejection fraction and cardiovascular risk factors, served as a control group. Long-axis LV function assessment was done with tissue Doppler imaging at 3 weeks, 6 months, and 12 months after AVR. Results: Mean aortic valve area in the AS group was 0.70 +/- 0.24 cm2. Pre-AVR peak systolic mitral annular velocities were significantly lower compared to controls (6.7 +/- 1.5 vs. 8.9 +/- 2.0 cm/s, P < 0.05). Post-AVR peak systolic mitral annular velocities improved to 9.1 +/- 2.9 at 3 weeks, 8.6 +/- 2.7 at 6 months, and 8.1 +/- 1.7 cm/s at 12 months (P < 0.05). Improvements were seen over the whole range of pre-AVR peak systolic mitral annular velocities. Patients with improved Sm after AVR (defined as >= 10% compared to baseline values) did not differ in baseline characteristics as compared to those who did not improve. Conclusions: In patients with severe AS and preserved LV ejection fraction, abnormal systolic mitral annular velocities improve after AVR, independent of the pre-AVR value. (Echocardiography 2010;27:1177-1181).