Home HOME Cardiology Letters 2022 Cardiology Letters Vol.31, No.1, p.23–28, 2022

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Cardiology Letters Vol.31, No.1, p.23–28, 2022

Title: Ventrikulo-ventrikulárna interakcia pri závažnej aortálnej stenóze / Ventriculo-ventricular interaction in severe aortal stenosis
Author: M. Dvorožňáková, P. Fülöp, G. Valočik

Abstract:

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. Fig. 4, Tab. 1, Ref. 22

Abstrakt. Ciele: V súčasnosti sa funkcia pravej komory (PK) u pacientov s aortálnou stenózou (AS) nedostatočne zohľadňuje v rozhodovacom procese náhrady aortálnej chlopne. Cieľom našej štúdie bolo zhodnotiť význam dysfunkcie PK u pacientov so závažnou AS modernými 3D echokardiografickými metodikami.
Metódy: Ide o prospektívnu analýzu 41 pacientov so závažnou AS, vysokogradientovou (HG – high gradient) a nízkogradientovou (LG – low gradient). Okrem základných echokardiografických parametrov sme hodnotili funkciu ľavej komory (ĽK) a PK na základe 3D rekonštrukcie prototypom programu na 3D analýzu dutín srdca. Hodnotili sme enddiastolické a endsystolické objemy ĽK a PK, ejekčnú frakciu (EF) a vývrhové objemy oboch komôr.
Výsledky: V skupine s LG AS bolo viac pacientov s dysfunkciou PK (definovanou EF PK < 45 %) ako v skupine s HG AS (90 % vs. 10 %, p = 0,01). Pacienti s LG AS mali horšiu funkciu PK ako pacienti s HG AS (EF PK 26 % vs. 40 %, p = 0,01). V dysfunkcii PK v podskupine s a bez pľúcnej hypertenzie nebol významný rozdiel (p = 0,08). Mnohonásobná regresná analýza ukázala, že jediným prediktorom funkcie PK je funkcia ĽK. Medzi EF ĽK a EF PK bola signifikantná korelácia (r = 0,74, p< 0,0001).
Závery: Z dosiahnutých výsledkov môžme konštatovať, že dysfunkcia PK je častejšia u pacientov s LG AS ako u pacientov s HG AS a jediným prediktorom dysfunkcie PK je dysfunkcia ĽK, pravdepodobne na podklade ventrikulo-ventrikulárnej interakcie. Pľúcna hypertenzia u pacientov so závažnou AS nepredikuje horšiu funkciu PK. Obr. 4, Tab. 1, Lit. 22,



Keywords: aortálna stenóza – nízkogradientová závažná aortálna stenóza – vysokogradientová závažná aortálna stenóza – transezofágová 3D echokardiografia - aortic stenosis – low gradient severe aortic stenosis – high gradient severe aortic stenosis – transesophageal 3D echocardiography
Published online: 21-Mar-2022
Year: 2022, Volume: 31, Issue: 1 Page From: 23, Page To: 28
doi:10.4149/Cardiol_2022_1_3
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