Pump and muscle functions and the index of perfusion of the subendocardium in severe aortic stenosis in adults
Marco, J.; Brut, A.; Gouel, Y.; Fournial, G.; Alibelli, M.J.; Bernadet, P.
Archives des Maladies du Coeur et des Vaisseaux 74(10): 1185-1196
1981
ISSN/ISBN: 0003-9683 PMID: 6796022 Document Number: 178521
47 patients with severe aortic stenosis (AS) (valve area less than 0.7 cm2) and normal coronary angiography were divided into three groups, according to their functional class (NYHA classification): - Group 1 (n = 21): Classes 1 and 2 - Group 2 (n = 18): Class 3 - Group 3 (n = 8): Class 4. Haemodynamic and angiographic parameters and the index of subendocardial perfusion (ISEP) defined by Buckberg's method were compared with a control group (n = 14). In group 1, pump function was normal without end diastolic dilatation. Moderate hypertrophy was compensatory and isofunctional (SW/mass = normal). Despite normal EF and VCF, contractile function was reduce (dp/dt/p, % shortening, % thickening and velocity of systolic thickening were lower than the control group (p less than 0.05)), and there was chronic subendocardial ischaemia (ISEP = 0.58 +/- 0.2, p less than 0.01). In groups 2 and 3, pump function was depressed (Group 2: CI = 2.5 +/- 0.5 1/min/m2 (p less than 0.05)) (Group 3: CI =2.0 +/- 0.6 1/min/m2, p less than 0.01)) despite an increased preload (LVEDP and EDV increased), and a greater degree of hypertrophy (Mass Index, Group 1 = 130 +/- 30 g/m2, Group 2 = 190 +/- 30 g/m2 (p less than 0.01), Group 3 = 210- +/- 30 g/m2 (p less than 0.01)). (SW/mass decreased, p less than 0.01). EF and VCF and all other indices of contractility were depressed and subendocardial ischaemia was the same (0.5 +/- 0.2). The complete lack of adaptation of the preload, non-compensatory hypertrophy, decreased contractility and chronic subendocardial ischaemia, all affect the operative prognosis and the long-term result after valve replacement. This data is in favour of early surgical correction of severe AS before the appearance of signs of cardiac failure.