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(Circulation. 2004;110:849-855.)
© 2004 American Heart Association, Inc.

Original Articles

Severe Aortic Stenosis and Myocardial Function

Diagnostic and Prognostic Usefulness of Ultrasonic Integrated Backscatter Analysis

Vitantonio Di Bello, MD; Davide Giorgi, MD; Paolo Viacava, MD; Talini Enrica, MD; Carmela Nardi, MD; Caterina Palagi, MD; Maria Grazia Delle Donne, MD; Francesco Verunelli, MD; Massimo A. Mariani, MD; Jean Grandjean, MD; Rita Dell’Anna, MD; Andrea Di Cori, MD; Giulio Zucchelli, MD; Maria Francesca Romano, MD; Mario Mariani, MD

From the Cardiac and Thoracic Department, University of Pisa, Italy (V.D.B., D.G., T.E., C.N., C.P., M.G.D.D., F.V., M.A.M., J.G., R.D., A.D.C., G.Z., M.M.); the Division of Pathology, Department of Oncology, Pisa, Italy (P.V.); and Sant’ Anna School of Advanced Study, Pisa, Italy (M.F.R.).

Correspondence to Vitantonio Di Bello, MD, Cardiac and Thoracic Department, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. E-mail vdibello{at}med.unipi.it

Received January 27, 2004; de novo received March 9, 2004; revision received April 29, 2004; accepted April 30, 2004.

Background— The aim of this study was to assess the myocardial reflectivity pattern in severe aortic valve stenosis through the use of integrated backscatter (IBS) analysis. Patients with aortic stenosis (AS) were carefully selected in the Department of Cardiology.

Methods and Results— Thirty-five subjects (AS: valve orifice 1 cm²; 12 female; mean age, 71.8±6.2 years) and 25 healthy subjects were studied. All subjects of the study had conventional 2D-Doppler echocardiography and IBS. Backscatter signal was sampled at the septum and posterior wall levels. Patients with AS were divided into 2 groups: 16 patients with initial signs of congestive heart failure and a depressed left ventricular systolic function (DSF) (ejection fraction [EF] range, 35% to 50%) and 19 asymptomatic patients with normal left ventricular systolic function (NSF) (EF >50%). Myocardial echo intensity (pericardium related) was significantly higher at the septum and posterior wall levels in DSF than in NSF and in control subjects. IBS variation, as an expression of variation of the signal, appeared to be significantly lower in AS with DSF than in NSF and in control subjects, at both the septum and posterior wall levels. Patients with DSF underwent aortic valve replacement, and, during surgical intervention, a septal myocardial biopsy was made for evaluation of myocardium/fibrosis ratio. Abnormally increased echo intensity was detected in left ventricular pressure overload by severe aortic stenosis and correlated with increase of myocardial collagen content (operating biopsy).

Conclusions— One year after aortic valve replacement, we observed a significant reduction of left ventricular mass, and, only if pericardial indexed IBS value (reduction of interstitial fibrosis) decreased, it was possible to observe an improvement of EF and of IBS variation.

Key Words: hypertrophy • ultrasonics • aorta • stenosis • valves

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