New Insight in the Assessment of Left Ventricular Function in Paradoxical Low Flow Aortic Stenosis Patients with Normal Left Ventricular Ejection Fraction: A Mini-Review
Paradoxical valvular aortic stenosis (VAS)
is a challenging area of clinical cardiology for the practitioners. It involves
a small aortic valve area, low flow rate and mean pressure gradient although
there is normal left ventricular ejection fraction. The aim of this study was
to assess left ventricular (LV) dysfunction in a symptomatic severe aortic
valve stenosis which is of crucial importance in identifying patients at risk
of heart failure, postoperative complications and increased mortality. There
are new insights which are involved in assessment of LV myocardial function
including global longitudinal strain (GLS) by two-dimensional speckle tracking
echocardiography (2D STE), myocardial performance index (MPI) and maximum rate
of LV pressure rise (+dP/dt) during isovolumetric contraction time of the LV.
This information can provide both diagnostic and prognostic information in
addition to standard echocardiographic and clinical parameters. However, a profound
understanding of the complex interaction between loading conditions, chamber
geometry and contractility is necessary for the correct interpretation of
myocardial deformation in order to draw appropriate conclusions in patients
with aortic valve disease. This mini review is related to new and novel
insights into the assessment of left ventricular function (LVF) in paradoxical
low flow aortic stenosis patients with normal left ventricular ejection
fraction (LVEF).
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