Left Atrioventricular Plane Displacement but Not Left Ventricular Ejection Fraction is Influenced by the Degree of Aortic Stenosis

Overview

Journal Heart

Date 2004 Sep 16

PMID 15367511

Citations 8

Authors

E RYDBERG

P Gudmundsson

L Kennedy

L Erhardt

R Willenheimer

Affiliations

Soon will be listed here.

Abstract

Aims: To examine how left atrioventricular plane displacement (AVPD), a widely used measure of left ventricular (LV) function, is related to presence and degree of aortic stenosis.

Methods And Results: Cardiac dimensions, LV filling, left AVPD, LV ejection fraction (LVEF), and valve function were assessed by echocardiography/Doppler in 182 patients with various cardiac diseases (mean (SD) age 69 (12) years, 36% women), 49 consecutive with and 133 consecutive without aortic stenosis. In an analysis of covariance, neither left AVPD nor LVEF was independently correlated with the presence of aortic stenosis. However, looking separately at patients with aortic stenosis, left AVPD (p = 0.03) but not LVEF correlated independently with degree of aortic stenosis in multiple linear regression analysis. In patients with aortic stenosis, an abnormal left AVPD had 94% sensitivity and 90% negative predictive value with regard to severe aortic stenosis, compared with 56% and 62%, respectively, for LVEF.

Conclusion: In patients with cardiac disease, neither left AVPD nor LVEF correlated independently with presence of aortic stenosis. However, in patients with aortic stenosis, left AVPD but not LVEF correlated with the degree of aortic valve obstruction and left AVPD but not LVEF had high sensitivity and negative predictive value with regard to severe aortic stenosis. Compared with LVEF, left AVPD is an earlier and more sensitive marker of LV haemodynamic load in patients with aortic stenosis.

Citing Articles

The role of conventional echocardiographic parameters on detecting subclinical anthracycline therapy related cardiac dysfunction-The SATRACD study.

Zhang W, Azibani F, Libhaber E, Nankabirwa J, Okello E, Kayima J Front Cardiovasc Med. 2022; 9:966230.

PMID: 36465474 PMC: 9716282. DOI: 10.3389/fcvm.2022.966230.

A new non-invasive index for prognosis evaluation in patients with aortic stenosis.

Sim H, Ngiam N, Zhong L, Tan B, Low L, Djohan A Sci Rep. 2020; 10(1):7333.

PMID: 32355310 PMC: 7193646. DOI: 10.1038/s41598-020-63777-z.

Expert consensus document on the assessment of the severity of aortic valve stenosis by echocardiography to provide diagnostic conclusiveness by standardized verifiable documentation.

Hagendorff A, Knebel F, Helfen A, Knierim J, Sinning C, Stobe S Clin Res Cardiol. 2019; 109(3):271-288.

PMID: 31482241 DOI: 10.1007/s00392-019-01539-2.

Value of low-dose dobutamine stress echocardiography on defining true severe low gradient aortic stenosis in patients with preserved left ventricular ejection fraction.

Liu D, Hu K, Liebner E, Weidemann F, Herrmann S, Ertl G Int J Cardiovasc Imaging. 2018; 34(12):1877-1887.

PMID: 30039338 PMC: 6245091. DOI: 10.1007/s10554-018-1416-z.

High sensitivity troponin T and I reflect mitral annular plane systolic excursion being assessed by cardiac magnetic resonance imaging.

Natale M, Behnes M, Kim S, Hoffmann J, Reckord N, Hoffmann U Eur J Med Res. 2017; 22(1):38.

PMID: 28978339 PMC: 5628434. DOI: 10.1186/s40001-017-0281-x.

References

Emilsson K, Wandt B . The relation between mitral annulus motion and ejection fraction changes with age and heart size. Clin Physiol. 2000; 20(1):38-43. DOI: 10.1046/j.1365-2281.2000.00221.x. View

Emilsson K, Wandt B . The relation between mitral annulus motion and left ventricular ejection fraction in atrial fibrillation. Clin Physiol. 2000; 20(1):44-9. DOI: 10.1046/j.1365-2281.2000.00222.x. View

Emilsson K, Wandt B . The relation between ejection fraction and mitral annulus motion before and after direct-current electrical cardioversion. Clin Physiol. 2000; 20(3):218-24. DOI: 10.1046/j.1365-2281.2000.00249.x. View

RYDBERG E, Willenheimer R, Brand B, Erhardt L . Left ventricular diastolic filling is related to the atrioventricular plane displacement in patients with coronary artery disease. Scand Cardiovasc J. 2001; 35(1):30-4. DOI: 10.1080/140174301750101447. View

Brand B, Rydberg E, Ericsson G, Gudmundsson P, Willenheimer R . Prognostication and risk stratification by assessment of left atrioventricular plane displacement in patients with myocardial infarction. Int J Cardiol. 2002; 83(1):35-41. DOI: 10.1016/s0167-5273(02)00007-4. View

Rydberg E, Arlbrandt M, Gudmundsson P, Erhardt L, Willenheimer R . Left atrioventricular plane displacement predicts cardiac mortality in patients with chronic atrial fibrillation. Int J Cardiol. 2003; 91(1):1-7. DOI: 10.1016/s0167-5273(02)00578-8. View

RYDBERG E, Erhardt L, Brand B, Willenheimer R . Left atrioventricular plane displacement determined by echocardiography: a clinically useful, independent predictor of mortality in patients with stable coronary artery disease. J Intern Med. 2003; 254(5):479-85. DOI: 10.1046/j.1365-2796.2003.01218.x. View

Gunther S, Grossman W . Determinants of ventricular function in pressure-overload hypertrophy in man. Circulation. 1979; 59(4):679-88. DOI: 10.1161/01.cir.59.4.679. View

Carabello B, GREEN L, Grossman W, Cohn L, Koster J, Collins Jr J . Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation. 1980; 62(1):42-8. DOI: 10.1161/01.cir.62.1.42. View

10.

DePace N, Ren J, Iskandrian A, Kotler M, Hakki A, SEGAL B . Correlation of echocardiographic wall stress and left ventricular pressure and function in aortic stenosis. Circulation. 1983; 67(4):854-9. DOI: 10.1161/01.cir.67.4.854. View

11.

Colan S, Borow K, Neumann A . Left ventricular end-systolic wall stress-velocity of fiber shortening relation: a load-independent index of myocardial contractility. J Am Coll Cardiol. 1984; 4(4):715-24. DOI: 10.1016/s0735-1097(84)80397-6. View

12.

ROSS Jr J . Afterload mismatch in aortic and mitral valve disease: implications for surgical therapy. J Am Coll Cardiol. 1985; 5(4):811-26. DOI: 10.1016/s0735-1097(85)80418-6. View

13.

Dineen E, Brent B . Aortic valve stenosis: comparison of patients with to those without chronic congestive heart failure. Am J Cardiol. 1986; 57(6):419-22. DOI: 10.1016/0002-9149(86)90764-2. View

14.

Devereux R, Alonso D, Lutas E, Gottlieb G, Campo E, Sachs I . Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986; 57(6):450-8. DOI: 10.1016/0002-9149(86)90771-x. View

15.

Otto C, Pearlman A, Comess K, Reamer R, Janko C, Huntsman L . Determination of the stenotic aortic valve area in adults using Doppler echocardiography. J Am Coll Cardiol. 1986; 7(3):509-17. DOI: 10.1016/s0735-1097(86)80460-0. View

16.

Lundback S . Cardiac pumping and function of the ventricular septum. Acta Physiol Scand Suppl. 1986; 550:1-101. View

17.

Appleton C, Hatle L, Popp R . Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988; 12(2):426-40. DOI: 10.1016/0735-1097(88)90416-0. View

18.

KRAYENBUEHL H, Hess O, Monrad E, Schneider J, Mall G, Turina M . Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement. Circulation. 1989; 79(4):744-55. DOI: 10.1161/01.cir.79.4.744. View

19.

Schiller N, Shah P, Crawford M, DeMaria A, Devereux R, FEIGENBAUM H . Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989; 2(5):358-67. DOI: 10.1016/s0894-7317(89)80014-8. View

20.

Alam M, Hoglund C, Thorstrand C, Philip A . Atrioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction. J Intern Med. 1990; 228(6):569-75. DOI: 10.1111/j.1365-2796.1990.tb00281.x. View