973Aortic valve area, stroke volume, left ventricular
                    hypertrophy, remodeling and fibrosis in aortic stenosis assessed by cardiac MRI.
                    Comparison between high and low gradient, and normal and low flow aortic
                    stenosis

Abstract Background Myocardial work (MW) is an innovative tool, that derives from myocardial strain with the advantage to incorporate measurement of deformation and load. Therefore, it could be useful in conditions of increased afterload, such as aortic stenosis (AS). To date, little is known about the changes in MW related to AS severity, left ventricle (LV) geometry and arterial compliance. Purpose We investigated the effect of valvulo-arterial impedance (Zva), stroke volume and LV hypertrophy in patients with AS and preserved LV ejection fraction (EF). Methods We retrospectively analyzed 283 patients (60% males, mean age 71±12 years old) with AS (aortic valve area ≤1.5 cm2) and LVEF≥50%. Exclusion criteria were more than mild associated cardiac valve lesion, left bundle branch block, and suboptimal quality of speckle-tracking image analysis. The control group included 50 patients matched for age and sex. Clinical, demographic and resting echocardiographic data were recorded, including quantification of 2D global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Results Patients with AS had higher systolic (p=0.017) and diastolic arterial pressure (p=0.007), increased LV wall thickness, mass index (p<0.001) and volumes (p=0.045) compared to controls. Greater indexed left atrial volume, E/e' and trans-tricuspid gradient were also observed in the AS group (p<0.001). As expected, speckle tracking analysis revealed significant lower GLS in AS than in control group (18.7±3.2 vs 20.7±2.1%, p<0.001). Conversely, increased values of GCW and GWI (respectively 2965±647 vs 2360±353 mmHg%, and 2535±559 vs 2005±302 mmHg%, p<0.001) were observed in patients with AS. Besides, GWW was significantly increased in AS vs controls (147±108 vs 90±49 mmHg%, p=0.001), with no changes in terms of GWE (95±4 vs 96±2%, p=0.110). When patients were stratified according to the AS severity, the analysis of variance revealed that GCW, GWI and GWW significantly increased with higher transaortic mean gradient and lower aortic valve area (p<0.001). Also Zva demonstrated to impact on CGW (p=0.040) and GWW (p<0.001), with increased values in presence of increased global LV afterload (Zva>4.5 mmHg/ml/m2). Conversely, patients with low-flow AS (stroke volume index <35 ml/m2) showed lowers values of GCW (p=0.014) and GWI (p=0.001) compared to normal flow AS, but increased GWW (p=0.041) and reduced GWE (93±7 vs 95±4%, p=0.010). Finally, LV geometry didn't influence significantly GCW and GWE, only an increase of GWW was observed in patients with eccentric hypertrophy (p=0.031). Conclusion In patients with AS and preserved LVEF, GLS reduction is accompanied by an increase of GCW, GWI and GWW, without affecting the GWE. These modifications seem to be correlated to the severity of AS, low-flow state and increased global LV afterload but not on the grade of LV hypertrophy.

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Impact of the Improvement of Valve Area Achieved With Aortic Valve Replacement on the Regression of Left Ventricular Hypertrophy in Patients With Pure Aortic Stenosis

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2004.09.002 ◽

2005 ◽

Vol 79 (4) ◽

pp. 1291-1296 ◽

Cited By ~ 36

Author(s):

Giordano Tasca ◽

Federico Brunelli ◽

Marco Cirillo ◽

Margherita Dalla Tomba ◽

Zen Mhagna ◽

...

Keyword(s):

Aortic Valve ◽

Left Ventricular Hypertrophy ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Valve Area

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Left Ventricular Hypertrophy in Isolated Aortic Stenosis: Primetime for the Ventricle

Current Pharmaceutical Biotechnology ◽

10.2174/1389201011208062503 ◽

2012 ◽

Vol 13 (13) ◽

pp. 2503-2514 ◽

Cited By ~ 5

Author(s):

Cristina Gavina ◽

Ines Falcao-Pires ◽

Francisco Rocha-Goncalves ◽

Adelino Leite-Moreira

Keyword(s):

Left Ventricular Hypertrophy ◽

Aortic Stenosis ◽

Ventricular Hypertrophy ◽

Left Ventricular

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Diagnostic Ability of Peguero-Lo Presti Electrocardiographic Left Ventricular Hypertrophy Criterion in Severe Aortic Stenosis

Journal of Clinical Medicine ◽

10.3390/jcm10132864 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2864

Author(s):

Aleksandra Gamrat ◽

Katarzyna Trojanowicz ◽

Michał A. Surdacki ◽

Aleksandra Budkiewicz ◽

Adrianna Wąsińska ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Aortic Stenosis ◽

Roc Curve ◽

Ventricular Hypertrophy ◽

Severe Aortic Stenosis ◽

Positive Likelihood Ratio ◽

Left Ventricular ◽

The Novel ◽

Operating Characteristics ◽

Diagnostic Ability

Traditional electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), introduced in the pre-echocardiographic era of diagnosis, have a relatively low sensitivity (usually not exceeding 25–40%) in detecting LVH. A novel Peguero-Lo Presti ECG-LVH criterion was recently shown to exhibit a higher sensitivity than the traditional ECG-LVH criteria in hypertension. Our aim was to test the diagnostic ability of the novel Peguero-Lo Presti ECG-LVH criterion in severe aortic stenosis. We retrospectively analyzed 12-lead ECG tracings and echocardiographic records from the index hospitalization of 50 patients with isolated severe aortic stenosis (mean age: 77 ± 10 years; 30 women and 20 men). Exclusion criteria included QRS > 120 ms, bundle branch blocks or left anterior fascicular block, a history of myocardial infarction, more than mild aortic or mitral regurgitation, and significant LV dysfunction by echocardiography. We compared the agreement of the novel Peguero-Lo Presti criterion and traditional ECG-LVH criteria with echocardiographic LVH (LV mass index > 95 g/m2 in women and >115 g/m2 in men). Echocardiographic LVH was found in 32 out of 50 study patients. The sensitivity of the Peguero-Lo Presti criterion in detecting LVH was improved (55% vs. 9–34%) at lower specificity (72% vs. 78–100%) in comparison to 8 single traditional ECG-LVH criteria. Additionally, the positive predictive value (77% vs. 72%), positive likelihood ratio (2.0 vs. 1.5), and odds ratio (3.2 vs. 2.4) were higher for the Peguero-Lo Presti criterion versus the presence of any of these 8 traditional ECG-LVH criteria. Cohen’s Kappa, a measure of concordance between ECG and echocardiography with regard to LVH, was 0.24 for the Peguero-Lo Presti criterion, −0.01–0.13 for single traditional criteria, and 0.20 for any traditional criterion. However, by the receiver operating characteristics (ROC) curve analysis, the overall ability to discriminate between patients with and without LVH was insignificantly lower for the Peguero-Lo Presti versus Cornell voltage as a continuous variable (area under the ROC curve: 0.65 (95% CI, 0.48–0.81) vs. 0.71 (0.55–0.86), p = 0.5). In conclusion, our preliminary results suggest a slightly better, albeit still low, agreement of the novel Peguero-Lo Presti ECG criterion compared to the traditional ECG-LVH criteria with echocardiographic LVH in severe aortic stenosis.

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