Circulation, Vol 72, 515-522, Copyright © 1985 by American Heart Association
KM Borow, SD Colan and A Neumann
Despite similar degrees of left ventricular systolic hypertension
shortening characteristics are usually greater in patients with congenital
valvular aortic stenosis (VAS) than in patients with coarctation of the
aorta (CoA). We hypothesized that these dissimilarities were caused by
differences in myocardial mechanics rather than by alterations in
contractile state. Eleven patients with VAS (ages 6 to 41 years) and 11
with CoA were matched for age, body surface area, and peak systolic
ejection gradient. Results were compared with data from 22 normal subjects
matched for age and body surface area. Echocardiographic tracings of the
left ventricle were recorded in conjunction with left ventricular pressure
measurements (VAS) or calibrated carotid pulse tracings (CoA and normal
subjects). Peak and end-systolic wall stresses as well as left ventricular
shortening fraction (% delta D) and rate-corrected velocity of fiber
shortening (Vcfc) were calculated. No differences for left ventricular
dimensions, heart rate or peak wall stress were present. Ventricular peak
systolic pressures and wall mass were higher for the patients with VAS or
CoA than for the normal subjects (p less than .001). These parameters did
not differ between the VAS and CoA groups. The patients with VAS had higher
% delta D and Vcfc than either the CoA or normal groups (p less than .01).
Afterload, as quantified by end-systolic stress, was 41% lower than normal
for the patients with VAS (p less than .001) and 13% higher than normal for
those with CoA (p less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Altered left ventricular mechanics in patients with valvular aortic stenosis and coarction of the aorta: effects on systolic performance and late outcome
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