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Reduced Systemic Arterial Compliance Impacts Significantly on Left Ventricular Afterload and Function in Aortic Stenosis

Implications for Diagnosis and Treatment

Martin Briand, MS^_*, Jean G. Dumesnil, MD, FACC^_*, Lyes Kadem, Eng, PhD^_*,, Antonio G. Tongue, MD^_*, Régis Rieu, Eng, PhD, Damien Garcia, Eng, PhD and Philippe Pibarot, DVM, PhD, FACC^_*,_*

^_* Research Group in Valvular Heart Diseases, Research Center of Laval Hospital/Quebec Heart Institute, Department of Medicine, Laval University, Sainte-Foy, Quebec, Canada
Laboratoire de Biomécanique Cardiovasculaire, Institut de Recherche sur les Phénomènes Hors Équilibre, Marseille, France
Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada

View larger version (16K): [in a new window]   Figure 1 Schematic representation of the flow and static pressure across the left ventricular (LV) outflow tract, aortic valve, and ascending aorta during systole. AA = aortic cross-sectional area; EOA = effective orifice area (i.e., the cross-sectional area of the vena contracta); LVSP = left ventricular systolic pressure; MGnet = transvalvular pressure gradient after pressure recovery (i.e., net MG); MGvc = transvalvular pressure gradient at the vena contracta; SAP = systolic aortic pressure; SAPvc = systolic aortic pressure at the vena contracta; SV = stroke volume; SVi = stroke volume index; ZVA = valvulo-arterial impedance.

View larger version (44K): [in a new window]   Figure 2 Comparison of the prevalence of left ventricular (LV) diastolic and systolic dysfunction in patients with moderate aortic stenosis (AS) and normal systemic arterial compliance (SAC) (group 1), patients with moderate AS and reduced SAC (group 2), patients with severe AS and normal SAC (group 3), and patients with severe AS and reduced SAC (group 4). *Significant difference versus group 1; significant difference versus group 2. CI = cardiac index; Dysf. = dysfunction; LV EF = left ventricular ejection fraction.

View larger version (11K): [in a new window]   Figure 3 Comparison of the valvulo-arterial impedance (Zva). *Significant difference versus group 1; significant difference versus group 2; significant difference versus group 3. Groups definitions as in Figure 2.