TY - JOUR
T1 - Changes in left ventricular diastolic performance after aortic balloon valvuloplasty
T2 - Acute and late effects
AU - Sheikh, K. H.
AU - Davidson, C. J.
AU - Honan, M. B.
AU - Skelton, T. N.
AU - Kisslo, K. B.
AU - Bashore, T. M.
N1 - Funding Information:
From the Department of Medicine, Division of Cardiology. Duke University Medical Center. Durham, North Carolina. This study was supported in part by Grants HL-07101, HL-I27IS and CA-37S86 from the U.S. Public Health Service. Washington. D.C. Manuscript received December 13. 1989: revised manuscript received April 11. 1990. accepted April 19. 1990. Address for reprints: Khalid H. Sheikh. MD. Box 3260. Duke University Medical Center. Durham. North Carolina 27710.
PY - 1990
Y1 - 1990
N2 - To evaluate acute and follow-up changes in left ventricular diastolic performance, simultaneous digital left ventriculography and micromanometry were performed in 49 patients undergoing aortic balloon valvuloplasty. All patients improved symptomatically after valvuloplasty, and 26 returned 6.3 ± 1.5 months later for follow-up catheterization. Immediately after valvuloplasty, aortic valve area increased (before 0.5 ± 0.2 versus after 0.8 ± 0.2 cm2, p < 0.01), cardiac output (before 4.3 ± 1.2 versus after 4.4 ± 1.3 liters/min) and ejection fraction (before 51 ± 18% versus after 52 ± 17%) did not change and diastolic indexes worsened, signified by a decrease in peak filling rate (before 247 ± 80 versus after 226 ± 78 ml/s, p < 0.01) and increase in the time constant of isovolumetric relaxation (π) (before 78 ± 29 versus after 96 ± 40 ms, p < 0.01) and the modulus of chamber stiffness (before 0.107 ± 0.071 versus after 0.141 ± 0.083, p < 0.01). At follow-up catheterization, 16 patients continued to have symptomatic improvement (group 1) and 10 had recurrence of symptoms (group 2). Aortic valve area, cardiac output and ejection fraction at follow-up catheterization in both groups were similar and unchanged from values before valvuloplasty. However, diastolic indexes and left ventricular mass were improved compared with values before valvuloplasty in group 1 and worse in group 2 as follows: peak filling rate: group 1 ±8% versus group 2 −20%, p = 0.001; time constant of isovolumetric relaxation: group 1 −11% versus group 2 ±35%, p = 0.008; chamber stiffness: group 1 −27% versus group 2 ±26%, p = 0.001; mass: group 1 −9% versus group 2 ±6%, p = 0.004. These data indicate that 1) diastolic performance worsens immediately after valvuloplasty, consistent with the development of ischemia during balloon inflation; and 2) changes in left ventricular diastolic indexes and mass, rather than aortic valve area or systolic indexes, correlate best with symptomatic status 6 months after valvuloplasty.
AB - To evaluate acute and follow-up changes in left ventricular diastolic performance, simultaneous digital left ventriculography and micromanometry were performed in 49 patients undergoing aortic balloon valvuloplasty. All patients improved symptomatically after valvuloplasty, and 26 returned 6.3 ± 1.5 months later for follow-up catheterization. Immediately after valvuloplasty, aortic valve area increased (before 0.5 ± 0.2 versus after 0.8 ± 0.2 cm2, p < 0.01), cardiac output (before 4.3 ± 1.2 versus after 4.4 ± 1.3 liters/min) and ejection fraction (before 51 ± 18% versus after 52 ± 17%) did not change and diastolic indexes worsened, signified by a decrease in peak filling rate (before 247 ± 80 versus after 226 ± 78 ml/s, p < 0.01) and increase in the time constant of isovolumetric relaxation (π) (before 78 ± 29 versus after 96 ± 40 ms, p < 0.01) and the modulus of chamber stiffness (before 0.107 ± 0.071 versus after 0.141 ± 0.083, p < 0.01). At follow-up catheterization, 16 patients continued to have symptomatic improvement (group 1) and 10 had recurrence of symptoms (group 2). Aortic valve area, cardiac output and ejection fraction at follow-up catheterization in both groups were similar and unchanged from values before valvuloplasty. However, diastolic indexes and left ventricular mass were improved compared with values before valvuloplasty in group 1 and worse in group 2 as follows: peak filling rate: group 1 ±8% versus group 2 −20%, p = 0.001; time constant of isovolumetric relaxation: group 1 −11% versus group 2 ±35%, p = 0.008; chamber stiffness: group 1 −27% versus group 2 ±26%, p = 0.001; mass: group 1 −9% versus group 2 ±6%, p = 0.004. These data indicate that 1) diastolic performance worsens immediately after valvuloplasty, consistent with the development of ischemia during balloon inflation; and 2) changes in left ventricular diastolic indexes and mass, rather than aortic valve area or systolic indexes, correlate best with symptomatic status 6 months after valvuloplasty.
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U2 - 10.1016/S0735-1097(10)80324-9
DO - 10.1016/S0735-1097(10)80324-9
M3 - Article
C2 - 2212360
AN - SCOPUS:0025130185
SN - 0735-1097
VL - 16
SP - 795
EP - 803
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -