Clinical Usefulness of Tissue Doppler Imaging in Patients with Mild to Moderate Aortic Stenosis: A Substudy of the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin Study

Jassal, Davinder S.; Tam, James W.; Dumesnil, Jean G.; Giannoccaro, Peter J.; Jue, John; Pandey, A. Shekhar; Joyner, Campbell D.; Teo, Koon K.; Chan, Kwan L.

doi:10.1016/j.echo.2008.02.014

« Previous Next »Journal of the American Society of Echocardiography
Volume 21, Issue 9 , Pages 1023-1027, September 2008

Clinical Usefulness of Tissue Doppler Imaging in Patients with Mild to Moderate Aortic Stenosis: A Substudy of the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin Study

Davinder S. Jassal, MD, FRCPC
- Cardiology Division, Department of Cardiac Sciences, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, Cardiology Division, Department of Cardiac Sciences, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
- Department of Radiology, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
- Reprint requests: Davinder S. Jassal, MD, FACC, FRCP(C), F.W. DuVal Clinical Research Professorship, Rm Y3010, Bergen Cardiac Care Centre, Cardiology Division, Department of Cardiac Sciences, St. Boniface General Hospital, 409 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6
James W. Tam, MD, FRCPC
- Cardiology Division, Department of Cardiac Sciences, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
Jean G. Dumesnil, MD, FRCPC
- Hopital Laval, Sainte-Foy, Quebec, Canada
Peter J. Giannoccaro, MD, FRCPC
- Peter Lougheed Centre, Calgary, Alberta, Canada
John Jue, MD, FRCPC
- Vancouver General Hospital, Vancouver, British Columbia, Canada
A. Shekhar Pandey, MD, FRCPC
- Cambridge Cardiac Care Centre, Cambridge, Ontario, Canada
Campbell D. Joyner, MD, FRCPC
- Sunnybrook HSC, Toronto, Ontario, Canada
Koon K. Teo, MD, FRCPC
- McMaster University, Hamilton, Ontario, Canada
Kwan L. Chan, MD, FRCPC
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada

published online 14 April 2008.

Objective

Although impaired diastolic function is common in aortic stenosis (AS), little is known about the clinical usefulness of tissue Doppler imaging (TDI) to detect diastolic dysfunction in patients with mild to moderate AS. The objective was to describe both conventional and TDI measurements of diastolic function in asymptomatic patients enrolled in the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin study, a multicenter study to assess the effect of rosuvastatin on the progression of AS.

Methods

Baseline echocardiography measurements, including left ventricular interventricular septal thickness, posterior wall thickness, cavity dimensions, and ejection fraction were obtained. Conventional Doppler indices, including peak early (E) and late (A) transmitral velocities, E/A ratio, and E-wave deceleration time, were measured from spectral Doppler. Tissue Doppler measurements, including early (E') and late (A') velocities of the lateral annulus, were determined, and E/E' was calculated.

Results

The study population included 172 patients (aged 57 ± 13 years; 73 were female) divided into three categories of AS severity on the basis of peak velocity at baseline (group I: 2.5-3.0 m/s; group II: 3.1-3.5 m/s; group III; 3.6-4.0 m/s). Baseline hemodynamics, left ventricular dimensions, and conventional diastolic functional parameters were similar among all 3 groups. In patients with greater severity of AS, the lateral E' was lower and the E/E' (as an estimate of increased left ventricular end-diastolic pressure) was higher (P <.05).

Conclusion

In patients with mild to moderate asymptomatic AS, TDI measures of diastolic function are abnormal and related to the severity of AS. These findings may help to predict the future development of symptoms in this population.

Keywords: Aortic stenosis, Diastolic dysfunction, Tissue Doppler