Normalization of diastolic dysfunction in aortic stenosis late after valve replacement

Bruno Villari, Giuseppe Vassaili, E. Scott Monrad, Massimo Chiariello, Marko Turina, Otto M. Hess

Research output: Contribution to journalArticle

184 Citations (Scopus)

Abstract

Background: The remodeling of the left ventricle in patients with aortic stenosis after aortic valve replacement (AVR) is a complex process involving structural and functional changes. Methods and Results: Twenty-two patients were included in the present analysis. Twelve patients with severe aortic stenosis were studied before surgery, early (22±8 months) and late (81±22 months) after AVR using left ventricular biplane angiograms, high-fidelity pressure measurements, and endomyocardial biopsies. Ten healthy subjects were used as controls. Left ventricular systolic function was assessed from biplane ejection fraction, and diastolic function from the time constant of relaxation, the peak filling rate, and the myocardial stiffness constant. Left ventricular structure was evaluated from interstitial fibrosis, fibrous content, and muscle fiber diameter. Left ventricular muscle mass was significantly increased before surgery in patients with aortic stenosis and remained increased early after surgery, although there was a 35% decrease. Late after AVR, muscle mass decreased significantly but remained slightly (P=NS) elevated. Left ventricular ejection fraction increased slightly after AVR. Left ventricular relaxation was significantly prolonged before surgery and returned toward normal early and late after AVR. Peak filling rates remained unchanged before and after surgery. Myocardial stiffness constant was increased before surgery in patients with aortic stenosis compared with controls and increased even further early after AVR but was normalized late after surgery. Muscle fiber diameter was elevated in patients with aortic stenosis before and after surgery compared with controls; however, it decreased significantly early and late after AVR with respect to preoperative data but remained hypertrophied even late after surgery. Interstitial fibrosis and fibrous contents were larger before surgery than in control subjects and increased even more early but decreased significantly late after AVR. Conclusions: Diastolic stiffness increases in aortic stenosis early after AVR parallel to the increase in interstitial fibrosis, whereas relaxation rate decreases with a reduction in left ventricular muscle mass. Late after AVR, both diastolic stiffness and relaxation are normalized due to the regression of both muscular and nonmuscular tissue. Thus, reversal of diastolic dysfunction in aortic stenosis takes years and is accompanied by a slow regression of interstitial fibrosis.

Original languageEnglish (US)
Pages (from-to)2353-2358
Number of pages6
JournalCirculation
Volume91
Issue number9
StatePublished - May 1 1995
Externally publishedYes

Fingerprint

Aortic Valve Stenosis
Aortic Valve
Fibrosis
Muscles
Ventricular Remodeling
Left Ventricular Function
Stroke Volume
Healthy Volunteers
Angiography
Biopsy
Pressure

Keywords

  • aorta
  • hypertrophy
  • myocardium
  • stenosis
  • valves

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Villari, B., Vassaili, G., Monrad, E. S., Chiariello, M., Turina, M., & Hess, O. M. (1995). Normalization of diastolic dysfunction in aortic stenosis late after valve replacement. Circulation, 91(9), 2353-2358.

Normalization of diastolic dysfunction in aortic stenosis late after valve replacement. / Villari, Bruno; Vassaili, Giuseppe; Monrad, E. Scott; Chiariello, Massimo; Turina, Marko; Hess, Otto M.

In: Circulation, Vol. 91, No. 9, 01.05.1995, p. 2353-2358.

Research output: Contribution to journalArticle

Villari, B, Vassaili, G, Monrad, ES, Chiariello, M, Turina, M & Hess, OM 1995, 'Normalization of diastolic dysfunction in aortic stenosis late after valve replacement', Circulation, vol. 91, no. 9, pp. 2353-2358.
Villari B, Vassaili G, Monrad ES, Chiariello M, Turina M, Hess OM. Normalization of diastolic dysfunction in aortic stenosis late after valve replacement. Circulation. 1995 May 1;91(9):2353-2358.
Villari, Bruno ; Vassaili, Giuseppe ; Monrad, E. Scott ; Chiariello, Massimo ; Turina, Marko ; Hess, Otto M. / Normalization of diastolic dysfunction in aortic stenosis late after valve replacement. In: Circulation. 1995 ; Vol. 91, No. 9. pp. 2353-2358.
@article{dcd18c57939a404cbc888e2e28b625ed,
title = "Normalization of diastolic dysfunction in aortic stenosis late after valve replacement",
abstract = "Background: The remodeling of the left ventricle in patients with aortic stenosis after aortic valve replacement (AVR) is a complex process involving structural and functional changes. Methods and Results: Twenty-two patients were included in the present analysis. Twelve patients with severe aortic stenosis were studied before surgery, early (22±8 months) and late (81±22 months) after AVR using left ventricular biplane angiograms, high-fidelity pressure measurements, and endomyocardial biopsies. Ten healthy subjects were used as controls. Left ventricular systolic function was assessed from biplane ejection fraction, and diastolic function from the time constant of relaxation, the peak filling rate, and the myocardial stiffness constant. Left ventricular structure was evaluated from interstitial fibrosis, fibrous content, and muscle fiber diameter. Left ventricular muscle mass was significantly increased before surgery in patients with aortic stenosis and remained increased early after surgery, although there was a 35{\%} decrease. Late after AVR, muscle mass decreased significantly but remained slightly (P=NS) elevated. Left ventricular ejection fraction increased slightly after AVR. Left ventricular relaxation was significantly prolonged before surgery and returned toward normal early and late after AVR. Peak filling rates remained unchanged before and after surgery. Myocardial stiffness constant was increased before surgery in patients with aortic stenosis compared with controls and increased even further early after AVR but was normalized late after surgery. Muscle fiber diameter was elevated in patients with aortic stenosis before and after surgery compared with controls; however, it decreased significantly early and late after AVR with respect to preoperative data but remained hypertrophied even late after surgery. Interstitial fibrosis and fibrous contents were larger before surgery than in control subjects and increased even more early but decreased significantly late after AVR. Conclusions: Diastolic stiffness increases in aortic stenosis early after AVR parallel to the increase in interstitial fibrosis, whereas relaxation rate decreases with a reduction in left ventricular muscle mass. Late after AVR, both diastolic stiffness and relaxation are normalized due to the regression of both muscular and nonmuscular tissue. Thus, reversal of diastolic dysfunction in aortic stenosis takes years and is accompanied by a slow regression of interstitial fibrosis.",
keywords = "aorta, hypertrophy, myocardium, stenosis, valves",
author = "Bruno Villari and Giuseppe Vassaili and Monrad, {E. Scott} and Massimo Chiariello and Marko Turina and Hess, {Otto M.}",
year = "1995",
month = "5",
day = "1",
language = "English (US)",
volume = "91",
pages = "2353--2358",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Normalization of diastolic dysfunction in aortic stenosis late after valve replacement

AU - Villari, Bruno

AU - Vassaili, Giuseppe

AU - Monrad, E. Scott

AU - Chiariello, Massimo

AU - Turina, Marko

AU - Hess, Otto M.

PY - 1995/5/1

Y1 - 1995/5/1

N2 - Background: The remodeling of the left ventricle in patients with aortic stenosis after aortic valve replacement (AVR) is a complex process involving structural and functional changes. Methods and Results: Twenty-two patients were included in the present analysis. Twelve patients with severe aortic stenosis were studied before surgery, early (22±8 months) and late (81±22 months) after AVR using left ventricular biplane angiograms, high-fidelity pressure measurements, and endomyocardial biopsies. Ten healthy subjects were used as controls. Left ventricular systolic function was assessed from biplane ejection fraction, and diastolic function from the time constant of relaxation, the peak filling rate, and the myocardial stiffness constant. Left ventricular structure was evaluated from interstitial fibrosis, fibrous content, and muscle fiber diameter. Left ventricular muscle mass was significantly increased before surgery in patients with aortic stenosis and remained increased early after surgery, although there was a 35% decrease. Late after AVR, muscle mass decreased significantly but remained slightly (P=NS) elevated. Left ventricular ejection fraction increased slightly after AVR. Left ventricular relaxation was significantly prolonged before surgery and returned toward normal early and late after AVR. Peak filling rates remained unchanged before and after surgery. Myocardial stiffness constant was increased before surgery in patients with aortic stenosis compared with controls and increased even further early after AVR but was normalized late after surgery. Muscle fiber diameter was elevated in patients with aortic stenosis before and after surgery compared with controls; however, it decreased significantly early and late after AVR with respect to preoperative data but remained hypertrophied even late after surgery. Interstitial fibrosis and fibrous contents were larger before surgery than in control subjects and increased even more early but decreased significantly late after AVR. Conclusions: Diastolic stiffness increases in aortic stenosis early after AVR parallel to the increase in interstitial fibrosis, whereas relaxation rate decreases with a reduction in left ventricular muscle mass. Late after AVR, both diastolic stiffness and relaxation are normalized due to the regression of both muscular and nonmuscular tissue. Thus, reversal of diastolic dysfunction in aortic stenosis takes years and is accompanied by a slow regression of interstitial fibrosis.

AB - Background: The remodeling of the left ventricle in patients with aortic stenosis after aortic valve replacement (AVR) is a complex process involving structural and functional changes. Methods and Results: Twenty-two patients were included in the present analysis. Twelve patients with severe aortic stenosis were studied before surgery, early (22±8 months) and late (81±22 months) after AVR using left ventricular biplane angiograms, high-fidelity pressure measurements, and endomyocardial biopsies. Ten healthy subjects were used as controls. Left ventricular systolic function was assessed from biplane ejection fraction, and diastolic function from the time constant of relaxation, the peak filling rate, and the myocardial stiffness constant. Left ventricular structure was evaluated from interstitial fibrosis, fibrous content, and muscle fiber diameter. Left ventricular muscle mass was significantly increased before surgery in patients with aortic stenosis and remained increased early after surgery, although there was a 35% decrease. Late after AVR, muscle mass decreased significantly but remained slightly (P=NS) elevated. Left ventricular ejection fraction increased slightly after AVR. Left ventricular relaxation was significantly prolonged before surgery and returned toward normal early and late after AVR. Peak filling rates remained unchanged before and after surgery. Myocardial stiffness constant was increased before surgery in patients with aortic stenosis compared with controls and increased even further early after AVR but was normalized late after surgery. Muscle fiber diameter was elevated in patients with aortic stenosis before and after surgery compared with controls; however, it decreased significantly early and late after AVR with respect to preoperative data but remained hypertrophied even late after surgery. Interstitial fibrosis and fibrous contents were larger before surgery than in control subjects and increased even more early but decreased significantly late after AVR. Conclusions: Diastolic stiffness increases in aortic stenosis early after AVR parallel to the increase in interstitial fibrosis, whereas relaxation rate decreases with a reduction in left ventricular muscle mass. Late after AVR, both diastolic stiffness and relaxation are normalized due to the regression of both muscular and nonmuscular tissue. Thus, reversal of diastolic dysfunction in aortic stenosis takes years and is accompanied by a slow regression of interstitial fibrosis.

KW - aorta

KW - hypertrophy

KW - myocardium

KW - stenosis

KW - valves

UR - http://www.scopus.com/inward/record.url?scp=0028945138&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028945138&partnerID=8YFLogxK

M3 - Article

C2 - 7729021

AN - SCOPUS:0028945138

VL - 91

SP - 2353

EP - 2358

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 9

ER -