Left Ventricular Diastolic Function in Children and Young Adults with Congenital Aortic Valve Disease

Overview

Journal Am J Cardiol

Specialty Cardiology & Vascular Diseases

Date 2012 Oct 30

PMID 23102884

Citations 15

Authors

Kevin G Friedman

Doff B McElhinney

Jonathan Rhodes

Andrew J Powell

Steven D Colan

James E Lock

David W Brown

Affiliations

Soon will be listed here.

Abstract

Young patients with congenital aortic valve disease are at risk of left ventricular (LV) diastolic dysfunction (DD). We evaluated LV remodeling and the prevalence of, and risk factors for, DD in patients with aortic stenosis (AS), pure aortic regurgitation (AR), and AS+AR. Patients aged 8 to 39 years with congenital AS (n = 103), AR (n = 36), or AS+AR (n = 107) were identified. Cross-sectional assessment of the LV remodeling pattern and diastolic function was performed. A diastolic function score (DFS; range 0 to 4) was assigned to each patient, with 1 point for an abnormal value in each of 4 categories: mitral inflow (E/A and E-wave deceleration time), tissue Doppler E', E/E', and left atrial volume. Patients with a DFS of ≥2 were compared to those with a DFS <2. Concentric hypertrophy was the most common remodeling pattern in those with AS (51%), mixed/physiologic hypertrophy in those with AS+AR (48%) and eccentric hypertrophy in those with AR (49%) predominated. In the entire cohort, 91 patients (37%) had a DFS of ≥2. Patients with AS or AS+AR had greater DFS than those with pure AR (p <0.001). On multivariate analysis, a greater LV mass z-score and previous aortic valve balloon dilation were associated with a DFS of ≥2. In patients with catheterization data (n = 65), E/E' correlated with LV end-diastolic pressure. Those with a DFS of ≥2 had a greater LV end-diastolic pressure and mean pulmonary artery pressure than those with a DFS <2. In conclusion, DD is common in young patients with AS and AS+AR but not in those with pure AR. A greater LV mass and previous aortic valve dilation were associated with DD.

Citing Articles

Tuning Into the Left Ventricle's Diastolic Dance Following Pulmonary Valve Replacement-Be Aware!.

Gusseva M, Divekar A J Soc Cardiovasc Angiogr Interv. 2024; 3(4):101346.

PMID: 39130183 PMC: 11308030. DOI: 10.1016/j.jscai.2024.101346.

Echocardiography in Simple Congenital Heart Diseases: Guiding Adult Patient Management.

Galzerano D, Pergola V, Eltayeb A, Ludovica F, Arbili L, Tashkandi L J Cardiovasc Echogr. 2024; 33(4):171-182.

PMID: 38486692 PMC: 10936704. DOI: 10.4103/jcecho.jcecho_52_23.

Exploring the Possible Impact of Echocardiographic Diastolic Function Parameters on Outcome in Paediatric Dilated Cardiomyopathy.

Bressieux-Degueldre S, Fenton M, Dominguez T, Burch M Children (Basel). 2022; 9(10).

PMID: 36291436 PMC: 9600896. DOI: 10.3390/children9101500.

Heart Failure with Preserved Ejection Fraction in Children.

Das B, Deshpande S, Akam-Venkata J, Shakti D, Moskowitz W, Lipshultz S Pediatr Cardiol. 2022; 44(3):513-529.

PMID: 35978175 DOI: 10.1007/s00246-022-02960-7.

Peri-operative changes in diastolic function and outcomes in congenital aortic valve surgery.

Pesce M, LaPar D, Kalfa D, Bacha E, Freud L Echocardiography. 2022; 39(2):178-184.

PMID: 35014728 PMC: 9305218. DOI: 10.1111/echo.15274.

References

Stewart R, Kerr A, Whalley G, Legget M, Zeng I, Williams M . Left ventricular systolic and diastolic function assessed by tissue Doppler imaging and outcome in asymptomatic aortic stenosis. Eur Heart J. 2010; 31(18):2216-22. DOI: 10.1093/eurheartj/ehq159. View

Chin C, Chen C, Chen C, Chen T, Chang M, Chiou H . Prediction of severity of isolated aortic regurgitation by echocardiography: an aortic regurgitation index study. J Am Soc Echocardiogr. 2005; 18(10):1007-13. DOI: 10.1016/j.echo.2005.03.004. View

Cayli M, Kanadasi M, Akpinar O, Usal A, Poyrazoglu H . Diastolic function predicts outcome after aortic valve replacement in patients with chronic severe aortic regurgitation. Clin Cardiol. 2009; 32(8):E19-23. PMC: 6653483. DOI: 10.1002/clc.20437. View

Weidemann F, Herrmann S, Stork S, Niemann M, Frantz S, Lange V . Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009; 120(7):577-84. DOI: 10.1161/CIRCULATIONAHA.108.847772. View

Zile M, Baicu C, Gaasch W . Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004; 350(19):1953-9. DOI: 10.1056/NEJMoa032566. View

Vlahos A, Marx G, McElhinney D, ONeill S, Goudevenos I, Colan S . Clinical utility of Doppler echocardiography in assessing aortic stenosis severity and predicting need for intervention in children. Pediatr Cardiol. 2007; 29(3):507-14. DOI: 10.1007/s00246-007-9169-9. View

Nagueh S, Middleton K, Kopelen H, Zoghbi W, Quinones M . Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997; 30(6):1527-33. DOI: 10.1016/s0735-1097(97)00344-6. View

Grewal J, McCully R, Kane G, Lam C, Pellikka P . Left ventricular function and exercise capacity. JAMA. 2009; 301(3):286-94. PMC: 2862454. DOI: 10.1001/jama.2008.1022. View

Casaclang-Verzosa G, Nkomo V, Sarano M, Malouf J, Miller Jr F, Oh J . E/Ea is the major determinant of pulmonary artery pressure in moderate to severe aortic stenosis. J Am Soc Echocardiogr. 2008; 21(7):824-7. DOI: 10.1016/j.echo.2007.12.002. View

10.

Peterson K, Tsuji J, Johnson A, DiDonna J, LeWinter M . Diastolic left ventricular pressure-volume and stress-strain relations in patients with valvular aortic stenosis and left ventricular hypertrophy. Circulation. 1978; 58(1):77-89. DOI: 10.1161/01.cir.58.1.77. View

11.

Beroukhim R, Graham D, Margossian R, Brown D, Geva T, Colan S . An echocardiographic model predicting severity of aortic regurgitation in congenital heart disease. Circ Cardiovasc Imaging. 2010; 3(5):542-9. DOI: 10.1161/CIRCIMAGING.110.957175. View

12.

Pritchett A, Mahoney D, Jacobsen S, Rodeheffer R, Karon B, Redfield M . Diastolic dysfunction and left atrial volume: a population-based study. J Am Coll Cardiol. 2005; 45(1):87-92. DOI: 10.1016/j.jacc.2004.09.054. View

13.

Robinson J, Del Nido P, Geggel R, Perez-Atayde A, Lock J, Powell A . Left ventricular diastolic heart failure in teenagers who underwent balloon aortic valvuloplasty in early infancy. Am J Cardiol. 2010; 106(3):426-9. DOI: 10.1016/j.amjcard.2010.03.045. View

14.

Zile M, Gaasch W . Abnormal calcium homeostasis: one mechanism in diastolic heart failure. J Am Coll Cardiol. 2011; 58(2):155-7. DOI: 10.1016/j.jacc.2010.10.068. View

15.

Friedman K, Margossian R, Graham D, Harrild D, Emani S, Wilkins-Haug L . Postnatal left ventricular diastolic function after fetal aortic valvuloplasty. Am J Cardiol. 2011; 108(4):556-60. PMC: 3374950. DOI: 10.1016/j.amjcard.2011.03.085. View

16.

LINZBACH A . Heart failure from the point of view of quantitative anatomy. Am J Cardiol. 1960; 5:370-82. DOI: 10.1016/0002-9149(60)90084-9. View

17.

Villari B, Hess O, Kaufmann P, Krogmann O, Grimm J, KRAYENBUEHL H . Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic and diastolic function. Am J Cardiol. 1992; 69(9):927-34. DOI: 10.1016/0002-9149(92)90795-z. View

18.

Spencer A, Hart J, Cabreriza S, Rabkin D, Weinberg A, Spotnitz H . Aortic regurgitation in the heterotopic rat heart transplant: effect on ventricular remodeling and diastolic function. J Heart Lung Transplant. 2003; 22(8):937-45. DOI: 10.1016/s1053-2498(02)00816-1. View

19.

Gjertsson P, Caidahl K, Bech-Hanssen O . Left ventricular diastolic dysfunction late after aortic valve replacement in patients with aortic stenosis. Am J Cardiol. 2005; 96(5):722-7. DOI: 10.1016/j.amjcard.2005.04.052. View

20.

Lamb H, Beyerbacht H, de Roos A, van der Laarse A, Vliegen H, Leujes F . Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitation. J Am Coll Cardiol. 2002; 40(12):2182-8. DOI: 10.1016/s0735-1097(02)02604-9. View