Relationship of Ventricular Function and Morphometry in Patients with Symptomatic Severe Aortic Stenosis

Alejandro Hita, Martín Donato, Sergio Baratta, Demián Chejtman, Ricardo A. Costantini, Juan M. Telayna, Mirian Matoso, Celina Morales, Ricardo J. Gelpi, José Navia

Abstract


Objectives

To evaluate systolic and diastolic ventricular function in patients

with symptomatic severe aortic stenosis with preserved

ejection fraction and its correlation with collagen volume

fraction and myocyte cross-sectional area.

Material and Methods

A total of 12 patients with symptomatic severe aortic stenosis

were evaluated and compared with 6 patients without

valvular heart disease; mean age was 65±13 years and 58%

were men. All patients underwent tissue Doppler imaging

and cardiac catheterization. Endomyocardial biopsies were

obtained to determine collagen volume fraction and myocyte

cross-sectional area (

mm2).

Results

Mean collagen volume was 6.1±0.7%; mean myocyte crosssectional

area was 388.4±15.8

mm2

and median strain in the

basal septum was 14% (IIC 6.9-19). There was a significant

correlation between septal strain measured by tissue Doppler

imaging and collagen volume fraction (correlation coefficient

–0.79; p = 0.03). We found no correlation between septal

strain and myocyte cross-sectional area (R

2

= 0.15; p = 0.8).

The max positive dP/dt normalized for left ventricular enddiastolic

pressure obtained during cardiac catheterization

had a negative correlation with the myocyte cross-sectional

area (R –0.94; p = 0.005).The time constant of pressure decay

(tau) increased by 55%±3,5% (p <0,05) and had a positive

correlation with the myocyte cross-sectional area (R = 0.81;

p = 0.04).

Conclusion

This study demonstrates the presence of anomalies in diastolic

and systolic function in patients with symptomatic severe

aortic stenosis and preserved ejection fraction that correlate

with structural changes in the left ventricle, represented by

increased interstitial collagen volume fraction and myocyte

cross-sectional area.


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar