Cardiology Letters 2022, 31(1):23-28

Ventriculo-ventricular interaction in severe aortal stenosis

Dvorožňáková M¹, Fülöp P², Valočik G³

¹ II. Kardiologická klinika, Východoslovenský ústav srdcových a cievnych chorôb, a. s. a UPJŠ LF, Košice

² Interná klinika, Košice Šaca a UPJŠ LF, Košice

³ I. Kardiologická klinika, Východoslovenský ústav srdcových a cievnych chorôb, a. s. a UPJŠ LF, Košice, Slovenská republika

Aims: At the present time, the right ventricular (RV) function in patients with aortic stenosis (AS) is insufficiently taken into account in the decision-making process of aortic valve replacement. The aim of our study was to evaluate by modern 3D echocardiographic methods the significance of RV dysfunction in patients with severe AS.

Methods: This is a prospective analysis of 41 patients with severe high gradient (HG) and low gradient (LG) AS. In addition to basic echocardiographic parameters, we evaluated the function of the left ventricle (LV) and RV on the basis of 3D reconstruction using a prototype program for 3D analysis of heart chambers. Enddiastolic, endsystolic volumes of the LV and RV, ejection fraction (EF) and stroke volumes of both chambers were assessed.

Results: There were more patients with RV dysfunction in the LG AS group (defined as RV EF < 45%) than in the HG AS group (90% vs 10%, p=0.01). Patients with LG AS had worse RV function than patients with HG AS (RV EF 26% vs 40%, p=0.01). There was no significant difference in RV dysfunction in the subgroup of patients with and without pulmonary hypertension (p = 0.08). Multiple regression analysis revealed that the only predictor of RV function is the LV function. There was significant correlation between LV EF and RV EF (r=0.74, p<0.0001).

Conclusions: According to our results we can state that RV dysfunction is more common in patients with LG AS than in patients with HG AS and the only predictor of RV dysfunction is LV dysfunction, probably based on ventriculo-ventricular interaction. Pulmonary hypertension in patients with severe AS does not predict RV dysfunction.

Keywords: aortic stenosis; low gradient severe aortic stenosis; high gradient severe aortic stenosis transesophageal 3D echocardiography

Published: January 1, 2022  Show citation