Left ventricular systolic function in aortic stenosis

H. P. Krayenbuehl, O. M. Hess, M. Ritter, E. Scott Monrad, H. Hoppeler

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

In aortic valve stenosis, concentric hypertrophy develops which is characterized by a reduced end-diastolic radius-to-wall thickness ratio (r/h) with an essentially normal cavity shape. As long as the product of (r/h) and LV systolic pressure remains constant, hypertrophy is appropriate. An increase in the product, which represents an increase in wall stress signals inadequate LV hypertrophy. Although at first glance, massive LV hypertrophy appears favourable for the maintenance of a normal LV ejection fraction in aortic stenosis, data from 23 studies of the literature have shown an inverse relationship between ejection fraction and LV angiographic mass m-2 (r = -0.59). Both a degree of hypertrophy inadequate to keep systolic wall stress within normal limits and a reduction of LV contractility may explain the depression of ejection fraction when LV angiographic mass is sizeably increased. Conversely, a normal ejection fraction in aortic stenosis may not be indicative of normal systolic myocardial function under all circumstances. In the presence of mildly reduced contractility, a normal ejection fraction may be maintained by use of preload reseve. Assessment of myocardial structure from LV endomyocardial biopsies revealed no differences in muscle fibre diameter, interstitial fibrosis and volume fraction of myofibrils between patients with aortic stenosis having a normal and those with a depressed ejection fraction. Preoperative ejection fraction is a poor predictor of postoperative survival, whereas markedly increased preoperative angiographic mass and end-systolic volume have been reported to predict an unsatisfactory postoperative outcome characterized by either death or poor LV function.

Original languageEnglish (US)
Pages (from-to)19-23
Number of pages5
JournalEuropean Heart Journal
Volume9
Issue numberSUPPL. E
StatePublished - 1988
Externally publishedYes

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Aortic Valve Stenosis
Left Ventricular Function
Hypertrophy
Myofibrils
Fibrosis
Maintenance
Blood Pressure
Biopsy
Muscles
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Krayenbuehl, H. P., Hess, O. M., Ritter, M., Monrad, E. S., & Hoppeler, H. (1988). Left ventricular systolic function in aortic stenosis. European Heart Journal, 9(SUPPL. E), 19-23.

Left ventricular systolic function in aortic stenosis. / Krayenbuehl, H. P.; Hess, O. M.; Ritter, M.; Monrad, E. Scott; Hoppeler, H.

In: European Heart Journal, Vol. 9, No. SUPPL. E, 1988, p. 19-23.

Research output: Contribution to journalArticle

Krayenbuehl, HP, Hess, OM, Ritter, M, Monrad, ES & Hoppeler, H 1988, 'Left ventricular systolic function in aortic stenosis', European Heart Journal, vol. 9, no. SUPPL. E, pp. 19-23.
Krayenbuehl HP, Hess OM, Ritter M, Monrad ES, Hoppeler H. Left ventricular systolic function in aortic stenosis. European Heart Journal. 1988;9(SUPPL. E):19-23.
Krayenbuehl, H. P. ; Hess, O. M. ; Ritter, M. ; Monrad, E. Scott ; Hoppeler, H. / Left ventricular systolic function in aortic stenosis. In: European Heart Journal. 1988 ; Vol. 9, No. SUPPL. E. pp. 19-23.
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