Immediate and short-term effects of aortic balloon valvuloplasty on left ventricular diastolic function and filling in humans
MF Stoddard,
MG Vandormael,
AC Pearson,
C Gudipati,
MJ Kern,
U Deligonul,
and
AJ Labovitz
Department of Internal Medicine, St. Louis University School of Medicine, Missouri.
The effect of aortic balloon valvuloplasty on left ventricular diastolic function and filling was investigated in 44 adult patients with severe aortic stenosis. Two-dimensional and Doppler echocardiography was performed in all patients before and 24 h after valvuloplasty. In 19 patients (short-term group) repeat studies were performed at 3 (n = 2) and 6 (n = 17) months. Left ventricular relaxation, chamber stiffness and filling were assessed in 16 patients (immediate post-valvuloplasty group) before and immediately after valvuloplasty by simultaneous micromanometer left ventricular pressure tracings and echocardiograms. Immediately after valvuloplasty, relaxation was slightly impaired in the immediate post-valvuloplasty group, as reflected by the isovolumic relaxation time constant (56 +/- 26 to 68 +/- 39 ms; p less than 0.01) and maximal negative dP/dt (2,063 +/- 640 to 1,767 +/- 495 mm Hg/s; p less than 0.001). The chamber stiffness constants and diastolic filling dynamics were unchanged immediately after valvuloplasty. Twenty-four hours after valvuloplasty, patients without mitral regurgitation (n = 24) showed increases in the peak early filling velocity (72 +/- 31 to 83 +/- 28 cm/s; p less than 0.05) and peak early to atrial filling velocity ratio (0.8 +/- 0.6 to 1.0 +/- 0.7; p less than 0.05). However, in patients with mitral regurgitation (n = 20), the diastolic filling dynamics were not significantly changed. In the short-term group at the 3 to 6 month follow-up period, patients without mitral regurgitation (n = 12) showed striking increases compared with pre-valvuloplasty values in the peak early filling velocity (66 +/- 21 to 93 +/- 31 cm/s; p less than 0.02), peak early to atrial filling velocity ratio (0.6 +/- 0.2 to 0.9 +/- 0.4; p less than 0.02) and early time-velocity integral (9 +/- 4 to 16 +/- 6 cm; p less than 0.002). In patients with mitral regurgitation (n = 7) decreases occurred in the peak early filling velocity (123 +/- 32 to 106 +/- 28 cm/s; p less than 0.05) and peak early to atrial filling velocity ratio (1.5 +/- 0.7 to 1.1 +/- 0.6; p less than 0.05). Functional class in hospital improved after valvuloplasty (3.1 +/- 1.0 to 2.6 +/- 0.9; p less than 0.001) and correlated modestly with the percent decrease in Doppler-derived peak gradient (rs = 0.41, p less than 0.02) and mean gradient (rs = 0.36, p less than 0.05), but did not correlate with changes in aortic valve area, left ventricular ejection fraction or diastolic filling variables.(ABSTRACT TRUNCATED AT 400 WORDS)
