$74
Abstracts
younger females and Aortic Valve disease (AVD) among males. Although overall
more women have HVD they may undergo less surgical procedures raising the
possibility of a gender bias. The objective of this study was to look at the pattern
of distribution of HVD among men and women and evaluate any gender bias on
surgical interventions they had received, in the baseline data of a large cohort of
patients with HVD.
Methods: Baseline data from the HVD follow up clinic was evaluated, which strictly
follows the current ESC and AHA guidelines. In patients who had undergone surgical intervention, their primary valvular lesion has been taken as the primary diagnosis.
Results: Total 504 patients (254 men, 250 women); mean age was 67 (Standard
deviation (SD) 14) with range 17 to 89 years. Distribution of HVD in the total population were Mitral Stenosis (MS)- 47, Mitral Regurgitation (MR)-200, Aortic Stenosis
(AS)- 180, Aortic Regurgitation (AR)-238, Pulmonary stenosis (PS) -5, Tricuspid
regurgitation (TR)-5, Mechanical Prosthesis (MP)- 125, Bio-prosthesis (BP)- 57,
Valve repair (VR)-17, Valvuloplasty-2. Much higher Aortic Valve disease (AVD)
82.5% (418) compared to Mitral valve disease (MVD) 247(49%) was observed.
The HVD distribution pattern among men and women were Men with MS-17, MR97, AS-106, AR-112, PS-2, TR-3 where as Women with MS-30, MR-103, AS-74,
AR-126, PS-3, TR-2. Surgical procedures carried out in men MP-72, BP-34, VR-9,
Valvuloplasty-1, and in women MP-53, BP-23, VR-8, valvuloplasty-l. Out of 201
procedures carried out only 42% were females.
Conclusion; In this cohort AVD had much higher incidence than MVD in contrast
to other studies perhaps reflecting the older mean age. There was no significant
difference among men and women with respect to the distribution of valve disease.
Despite equal population size a smaller percentage of women had undergone prior
surgical intervention for HVD.
535
The influence of anticoagulant therapy in the evolution of large
pericardial effusions after cardiosurgery
S. Tomic 1, L. Jovovic 2, M. Zlatanovic 2, L. Trkulja 2, S. Trajic 2, M. Tomovic 2,
B. Djukanovic 2 . 1Dedinje Cardiovascular Center, Belgrade, Serbia and
Montenegro; eDedinje Cardiovascular Institute, Clinical of Cardiology, Belgrade,
Serbia and Montenegro
Purpose: The aim of the study was to indicate the crucial significance of anticoagulant therapy in the evolution of large pericardial effusions on the 5th postoperative
day after cardiosurgery.
Method: We used 2-D echocardiography in 2.252 patients (pts), who underwent
open heart surgery: aortocoronary bypass procedure (CABG 1.724), implantation
of artificial heart prosthesis (454), combined procedures (26) and other surgical
procedures. I group (CABG 1.724 pts) was treated with antiaggregation therapy
on the 2nd postoperative day, II group (artificial prosthesis in 454 pts) with anticoagulant therapy, III group (combined bypass and prosthesis in 26 pts) with antiaggregation and anticoagulant therapy and IV group (predominant reconstruction of
congenital heart disease and Batista surgery in 48 pts) was treated with antiaggregation and anticoagulant therapy.
Results: Sixty two percent (1.307/2.252) of patients had a pericardial effusion.
There was no significant difference in the incidence of effusion between the analyzed groups regarding a minimal (up to 5 mm separation between the epicardial
and pericardial surface), small (up to 10 mm) and a medium large effusion (up to
15 mm). The large effusions (over 15 mm) were statistically significantly more frequent (p<0.05) in the groups with anticoagulant therapy: II group (15.9%), III group
(15.4%), IV group (16.7%) in relation to the group with antiaggregation therapy (I
group, 5.3%).
Conclusion: In contrast to minimal, small or medium effusions, large pericardial
effusions occur more frequently in patients treated with anticoagulant therapy.
(EF)(r=0.61, p=0.001). In the HI group, LV EF and Em of basal septal, lateral and
inferior segments were significantly higher than the LI group (Table).
Table
LI Group (n=10)
HI Group (n=15)
p
7.63±2.51
8.74±1.99
8.304-2.68
8.33±1.94
55.84-7.55
9.96±2.39
11.33±1.68
10.294-1.70
8.62±1.39
65.334-3.79
0.029
0.002
0.03
0.66
<0.001
Septal Em (cm/s)
Lateral Em (cm/s)
Inferior Em (cm/s)
Anterior Em (cm/s)
EF %
Conclusion: In this study it was determined that in pts with MPMV, the intensity
of MB rises as the diastolic function improves. It has been also confirmed that a
positive relationship exists between LV systolic function and MBI. These findings
suggest that MB are formed by microcavitations which are produced by motions of
mechanic valve leaflets and heart walls.
537
Early echocardiographic remodelling with cardiac resynchronization in
patients with aortic prosthesis and ventricular dysfunction
E. Arbelo Lainez, A. Garcia Quintana, Iq Martin, M. Diaz Escofet, E. Caballero
Dorta, J.R. Ortega Trujillo, A. Delgado Espinosa, A. Medina Fernandez-Aceytuno.
Hosp#al Univ. de Gran Canaria Dr. Negrin, Servicio de Cardiologta, Las Palmas
de Gran Canaria, Spain
Introduction: Cardiac resynchronization therapy (CRT) has not been deeply studied in patients (p) with left bundle branch block (LBBB), ventricular dysfunction and
aortic prosthesis.
Objective: To evaluate CRT effects in p with aortic valve disease, treated with
valve prostheses, that exhibit severe left ventricular dysfunction, LBBB and class
Ill-IV (NYHA).
Material and methods: Between J une 2003 and April 2005, 9 p (mean age 62± 12
years, all males, QRS duration 185±22 ms) were treated with CRT 81 months
(range 3-254) after an aortic valve replacement (4 p with aortic stenosis and 5
p with aortic regurgitation). An echocardiography study was performed, before
and in the midterm follow up, and parameters like left ventricular dimensions, volumes, ejection fraction, quantification of mitral regurgitation, inter and intraventricular asynchrony were obtained. Mean time follow-up was 202 days (range 30-480).
Results: Shown in the table.
Resuits
NYHA
LVEDV(mL) LVESV(mL)
Basal
3.14-0.3 298±66
Follow up 1.64-0.5 232±60
p
0.01
0.01
EF (%)
rvlR(cm2) Inter(ms) Intra(ms)
2364-71 19.54-6.5 8.44-4.7 724-30 3354-87
151 ±50
36±8
4.1±2.3
54±30
87±47
0.01
0.04
ns
0.014
<0.01
536
Microbubbles detected by transthoracic echocardiography in patients
with prosthetic mitral valves and their relation with left ventricle diastolic
functions determined by tissue Doppler imaging
D. Hunerel, T. Goren, A.K. Bilge, A.R. Altunsu, B. Ozben, A. Oncul, M. Meric.
Istanbul Faculty of Medicine, Cardiology Dept., Istanbul, Turkey
Objective: A positive relationship has been shown between left ventricle (LV) systolic functions and microbubbles (MB) detected by echocardiography (TTE) in patients (pts) with mechanic prosthetic mitral valves (MPMV). Our aim was to determine the relationship between MB in pts with MPMV and LV diastolic functions
assessed by tissue Doppler imaging (TDI) method.
Methods: Twentyfive pts (16 women (64%) and mean age of 44-- 11 yrs)in sinus
rhythm with normally functioning MPMV were studied. The intensity of MB (MBI) in
the LV observed during diastole by TTE was graded as: Grade 0: no MB, Grade 1:
sparse MB and detected to half of LV, Grade 2: dense MB and detected in whole
of L',L Pts with a MBI of Grade 0 and Grade 1 constituted low intensity (LI) group
while pts with a MBI of Grade 2 constituted high intensity (HI) group. By pulsed
wave TDI, systolic (Sm), early diastolic (Em) and late diastolic (Am) velocities were
measured from basal septal, lateral, anterior and inferior walls.
Results: MBI was evaluated as Grade 0 in 3 pts (12%), Grade 1 in 7 pts (28%),
Grade 2 in 15 pts (60%). There was a positive relationship between MBI and
Em of bazal septal, lateral and inferior walls (respectively r=0.41, p=0.03; r=0.53,
p=0.006, r=0.45, p=0.02). No significant relationship was determined between MBI
and Sm. There was a positive relationship between MBI and ejection fraction
Eur J Echocardiography Abstracts Supplement, December 2005
Echo remodelling in 463 days follow up
Conclusion: Patients with aortic valve prosthesis, severe left ventricular dysfunction and asynchrony, exhibit early marked clinical and echocardiography improvement with cardiac resynchronization therapy, probably due to the abscense of a
primary myocardial disease and the predominance of asynchronous cardiomyopathy.
AORTIC
STENOSIS
539
The plasma brain natriuretic peptide level is associated with severity
index of echocardiography in aortic stenosis
S.J. Park, C.W. Gwak, J.Y. Hwang. GyeongSang National UniversityHosp#al,
Cardiology Department, Jinju, Korea, Republic of
Background: Brain natriuretic peptide (BN P) level is related to disease severity in
Abstracts
$75
aortic stenosis. The aim of this study was to assess the associations between BN P
level and disease severity in aortic stenosis.
Methods: Thirty-seven patients (20male; aged 714-8.4 years) with isolated aortic
stenosis underwent independent assessment of symptoms, transthoracic echocardiography and measurement of plasma levels of BNP. Results. Mean pressure
gradient was 634-24 mmHg and mean aortic valve area was 0.674-0.5 cm 2. 9 patients were classified as mild AS (PG mean<30mmHg), 13 patients as moderate
AS (PG mean 30-50 mmHg) and 15 patients as severe AS (PG mean>50mmHg).
At the study entry, Plasma BNP levels were higher in symptomatic patients than in
asymptomalic patients (BNP 352.34-529 vs 53.24-43.2 pg/ml, P<0.05). BNP levels increased with NYHA class (BNP 264-19 class II, 934-15 class III, 7214-605
class IV). Significant linear correlation BNP levels between transaortic pressure
gradients, fractional shortening-velocity ratio (FSVR), ejection fraction-velocity ratio (EFVR) as severity index of AS in echocardiography (r=0.57, r=-0.5 and r=-0.53;
all P<0.05). BNP was positively correlated with LVMI (r = 0.74, P<0.05) but no correlation was found between BNP and LVEF at resting state.
Conclusions: Plasma BNP levels are elevated in symptomatic patients with aortic
stenosis even though their LV systolic dysfunction were not overt at rest. Furthermore, BNP is closely related to echocardiographic indices reflecting severity of
aortic stenosis. This study suggests that measurement of BNP may complement
clinical and echocardiographic assessment of aortic stenosis, and could potentially
be used to monitor progression of disease non-invasively. These markers may also
be useful to identify the optimum time for surgery in AS.
sion (LAX), pulsed wave tissue Doppler at the mitral annulus (septal and lateral
E', A' and S) and effective valve area by the continuity equation were recorded for
each subject on both occasions.
Results Preoperatively EF ranged from 15 to 80% (median 65%, 5 subjects _<35%)
and from 20 to 80% (median 70%, 4 subjects _<35%) at 1 year. Mean valve area
was 0.9 (SD 0.6) cm 2 preoperatively and 1.6 (SD 0.6) cm 2 at 1 year. Preoperatively
mean distance walked was 317 (SD 141) m, and increased to 421 (SD 109) m at 1
year (Paired T test p< 0.0001). No global measures of systolic function were significantly correlated with Ex. Preoperative distance walked correlated negatively
with transmitral A velocity (p=0.004) and positively with septal (p= 0.016) and lateral (p= 0.034) LAX. At 1 year distance walked correlated positively with septal E'
(p=0.006), lateral E' (p=0.01), septal LAX (p= 0.005), and replacement valve area
(p= 0.003). One year exercise time correlated negatively with age (p<0.0001),
transmittal E velocity (p=0.016), A velocity (p=0.01), E deceleration time (p=0.017)
and lateral E/E' (p= 0.002). Forward stepwise linear regression showed that Ex
was determined predominantly by transmltral A preoperatively and by lateral E/E'
and age at 1 year.
Conclusion Exercise capacity during a 6 minute walk is related better to left ventricular diastolic and long axis systolic function than to global systolic function both
before and after aortic valve replacement.
540
The effect of aortic valve replacement on left ventricular deformation
properties in patients with severe aortic stenosis. Ultrasound strain
analysis
P. Claus 1, F. Weidemann 2 I. Decramer 1, M. McLaughlin 1, F.E. Rademakers 1,
L. Mertens 3, j. Strotmann 2, B. Bijnens 1. 1Catholic University Leuven,
T. Kukulski 1, B. Dziobek 1, W. Streb 1, M. Zembala 2, Z. Kalarus 1. ISilesian
Center for Heart Diseases, Dept. of Cardiology, Zabrze, Poland; 2Silesian Center
for Heart Diseases, Cardiosurgery, Transplantology Dept., Zabrze, Poland
Objective: Chronic pressure overload, myocardial hyperthrophy and fibrosis during the course of aortic stenosis have an impact on regional myocardial function
by changing its deformation properties. Strain imaging based on the Tissue Dopier
data is currently the only bedside technique that can quantitate regional deformation.
The aim of this study was to evaluate the changes in regional left ventricular (LV)
function post aortic valve replacement (AVR)
Methods: 30 consecutive pts (20 M, age 574-13y) with aortic stenosis who underwent AVR were analysed prospectively before and at 4904-175 days post AVR.
Patients in whom AVR was combined with CABG were excluded from the analysis.
According to preoperative LV performance pts were divided into gr 1 (EF 574-8%,
ESV 434-24 ml, EDV 984-40 ml, max gr. 1044-28 mmHg, AVA-0.84-0.3 cm 2) and
gr.2(EF 324-8%, EDV 183:1:27 ml, ESV 1284-20 ml, max gr 744-18 mmHg, AVA0.94-0.14 cm2). Tissue Doppler data were acquired at high frame rate for regional
myocardial deformation analysis using dedicated softwares (TVI 6.0, Speqle 3.52).
Septal segments served as a reference for longitudinal strain (End sys S) measuremenls.
Results: NYHA class was improved in all patients (2.254-0.85 vs 1.054-0.22 in gr
1 and 2.884-0.99 vs 1.24-0.44 in gr2, p<0.001, Mann-Whitney). Mass index (g/m 2)
was reduced by 764-37 in gr 1 and 774-28 in gr2 (p=NS paired t-test). For the rest
of results see table.
End-eye S
gr 1 (n=20)
beforeAVR postAVR
api-seg
0.15-}-0.08 0.21±0.0g
mid-seg
0.10±0.07 0.15±0.08
bas-seg
0.08±0.06 0.11±0.05
Mass index 250±88
170±40
EDV
98±40
86±23
ESV
57±8
60±5
paired t-est
gr 2 (n=10)
P
beforeAVR postAVR
0.06
0.04
0.03
0.0007
O.18
0.24
0.074-0.06
0.05±0.03
0.04±0.04
289±56
t 83±27
32±8
pairedt-rest
P
0.13±0.04
0.11±0.05
0.10±0.07
212±79
115±56
52±11
0.01
0.04
0.03
0.04
0.003
0.003
Conclusions: Despite of the similar degree of mass reduction after AVR in both
groups, patients with baseline impaired LV function showed higher relative improvemnt in longitudinal septal strain and global function indices. Quantitation of regional deformation yields additional information on contractile reserve of the chronically pressure overloaded LV.
541
Diastolic and long axis left ventricular function determine exercise
capacity before and alter aortic valve replacement
H. Rimington, J. Chambers on behalf of Valve Study Group. Guy's & St. Thomas"
Hospital, Cardiothoracic Centre, London, United Kingdom
Background It is assumed that aortic valve replacement (AVR) improves exercise
capacity (Ex), but there are little quantitative data to support this and the determinants of Ex are unknown.
Aim To identify the echocardiographic determinants of Ex before and after AVR.
Methods We performed transthoracic echocardiography and a 6 minute walk on
87 patients (59M, 28 E mean age 65 (SD 12.1) y) preoperatively and 1 year after
AVR. Lelt ventricular ejection fraction (EF), fractional shortening, stroke distance,
diastolic filling pattern (E and A velocity and E deceleration time), long axis excur-
542
Increased and prolonged active myocardial stress as compensation in
aortic stenosis
Department of Cardiology, L euven, Belgium; 2University Hospital Wurzburg,
Cardiology, Wurzburg, Germany; 3 University Hospitals Gasthuisberg, Pediatric
Cardiology, Leuven, Belgium
Background: To assess a true reduction in myocardial function in the presence
of a prolonged afterload increase, deformation parameters may not be sufficient
and measuring myocardial forces might add information. Recently, we developed a
method to estimate the active myocardial stress (AMS) using a mechanical model
of the left ventricle (LV).
Study aim: to assess AMS development in patients with aortic valve stenosis.
Methods: 5 patients with aortic valve stenosis (AS) but without heart failure were
compared to 5 age-matched normals (N) (no CAD) who underwent left heart
catheterization. A gray-scale and Doppler myocardial imaging study was performed (Vivid5, GE) to assess LV morphology and function. These data were combined with the LV pressure in a mechanical model (ellipsoid geometry). Throughout the cycle, the balance of forces between the elastic stress, the total wall stress
(from LVP and geometry) and the AMS was solved. The passive stress-strain relation was estimated during diastole (where AMS--0) and used in systole to calculate
the AMS. To assess hypertrophy, LV mass was calculated. Myocardial deformation
was quantified by radial peak systolic strain-rate(SR) and strain(S). The two groups
were compared using a Mann-Whitney U test.
Results: In AS versus N, deformation parameters were reduced (SR: 3.14-1.2
vs 5.14-1.5 l/s; p<0.01 and S: 294-15 vs 614-12%; p<0.05), LVM was increased
(4284-110 vs 2474-88 g;p<0.01) and LVP was highly increased (1894-37 vs
1174-10 mmHg; p<0.0001). In contrast to deformation, AMS development is typically prolonged during systole (Fig. 1) and peak AMS is increased (10.64-1.5 vs
8.14-0.5 kPa; p<0.05).
kPa Normal
30
Z5
I
~05
----'
I
0
kPa Aortic Stenosis
30
25
~
Activemyocardialstress
I ~1
LVPressure
Z0
(= tad a endocarda
;,
0
cardiac cycle
Figure 1
'- . . . . .
cardiac cycle
Conclusions: Left ventricles facing an aortic valve stenosis can compensate functionally at rest by increasing and prolonging their AMS development.
543
Rate of progression of aortic valve stenosis in patients with severe
coronary artery disease
P. Faria 1, M.J. Andrade 1, M. Canada 1, R. Ribeiras 1, S. Lima 1, C. Alves 2,
R. Gouveia 1, R. Seabra-Gomes 1. 1Hospital de Santa Cruz, Cardiology
Department, Lisbon, Portugal; 2Hospital Central do Funchal, Departamento de
Estatistica, Funchal, Portugal
Background: Coronary Artery Disease and Aortic Valve Stenosis (AVS) commonly coexists in the same patients (Pts). In this Pts, when CABG surgery is indicated the decision if and when to simultaneously perform aortic valve replacement
(AVR) is not clear-cut. Although predictors of progression of AVS have been identified namely the coexistence of CAD, high variability of progression remains in the
individual Pt.
Objective: To evaluate the rate of progression of AVS in Pts with severe CAD.
Eur J Echocardiography Abstracts Supplement, December 2005
S76
Abstracts
Methods: We retrospectively studied a group el 32 Pls (25 males) with CAD and
mild (Vmax _>2 and <3m/s), moderate (Vmax _>3 and <4m/s) or severe (Vmax
_>4m/s) AVS. All Pts had at least 2 echocardiographic studies (Echo I and Echo
II) _>6 months apart (264-17 months). At the time el Echo I, mean age was 724- 7
years. CAD risk factors such as hypertension, hypercholesteraemia, current smoking and diabetes were present in respectively 88%, 84%, 28% and 19% Pls. 11:1
had chronic renal failure not requiring dialysis and 23 (72%) were taking slalins.
Three-vessel CAD was present in 16 (50%),two-vessels in 11 (34°/0) and one vessel in 5 (16%). Previous M lwas present in 13 (40,6%) Pts, PTCA in 13 (40,6o/0)and
CABG in 14 (42,,7%). There were no patients with significant LV dyslunclion and
between the two echos no events occurred which could compromise LV lunclion.
Results: The results of Echo I and II are presented in the table. From Echo lie II,
11 Pts climbed to a more severe grade of AVS. The rate el increase el V.max. was
0,184-0,40m/s/year and el Peak Gradient was 6,54-12,4mmHg/year. Alter Echo II,
CABG with concurrent AVR was performed in 10 Pts, 3 of whom had previous
CABG _>8 years earlier.
N (%) Pts with mild/moderate/
severe AVE
Mean 4- Std V. max.
Mean 4- Btd Peak Gradient
Echo I
Echo II
P value
8(25%)/13(40.6%)! 4/(12,5%)/10(31,3%)/ P=0.001
11 (34,4%)
18(56,3%)
3,624-0,73m/s
3,994-0,83 m/s
P<0,0001
544-21mmHg
664-27mmHg
P<0,0001
Conclusion: In our Pls, the mean rate of progression el AVS (0,18m/s/year) was
not dilferenl lrom thal described for the general population with AVS. In the time
period of 26 months one third of our population moved to a more severe grade el
aortic valve slenosis. Elucidation about which laclors alfects individual progression
variability is warranted.
544
Impact of concomitant hypertension on left ventricular structure in
patients with aortic valve stsnosis. The SEAS study
A.E. Rieck 1, D. Cramariuc 1, E.M. Slaal 1, A. Rossebo 2, K. Wachtell 3,
E Gerdts 1 ~University of Bergen, Institute of Medicine, Bergen, Norway; 2Aker
University Hospital Division of Cardiology, Oslo, Norway; 3National Hospital The
Heart Center, Copenhagen, Denmark
Purpose: Both hypertension and aortic valve stenosis (AS) induce lell venlricular (LV) hypertrophy. However, less is known about the influence of concomitant
hypertension (HT) on LV structure in patients with AS.
Methods: Translhoracic Doppler echocardiography was perlormed at baseline on
1762 patients with mild to moderate asymptomalic AS (transaortic Doppler velocity
> 2,5 m/s and < 4,0 m/s) randomised in to the Simvaslalin and Ezetimibe in Aortic
Stenosis (SEAS) study. All studies were recorded and send for central reading at
the SEAS core laboratory at Haukeland University Hospital.
Results: The patients were grouped as normotensives (n=872) or hypertensives
(HT, n=890) according to history el hypertension. Based on aortic valve area/body
surface area the groups had similar degree el AS (0.66 vs 0.68 cm2/m 2 respectively). The HT group had significantly higher age, body mass inde(, systolic and
diastolic blood pressure as well as larger left atrial diameter, LV internal diameters,
wall thicknesses and LV mass (all p<0.05). Furthermore, the HT group had higher
prevalences of LV hypertrophy (39 vs 30%) and increased relative wall thickness
(20 vs 16%) (both p<0.05). In multivariate analysis, HT independently predicted
higher LV mass (multiple R2. = 0.24, p<0.001)(Table 1).
Table 1
Variable
Known HT
Age (years)
Body mass index (kg/m2)
Aortiovalve area/body surface area (em2/m2)
Ejection fraction (%)
Male Gender
Beta
0067
0002
0278
-0.002
-0.123
0379
t
2923
0073
12.267
-0.097
-5.517
16.779
P
0004
0942
<0001
0923
<0001
<0001
Conclusion: In patients with similar degree of asymptomalic mild to moderate AS,
concomitant HT is associated with higher LV mass as well as more concentric
hypertrophy. The clinical significance of these findings will be assessed in longterm lollow-u p.
545
Risk stratification in moderate and severe aortic valve stanosisprognostic impact of renal failure and diabetes mellitus
C. Bruch, D. Kauling, H. Reinecke, T. Wichter, G. Breithardt. WWUMunster,
Medizinische Klinik und Poliklinik C, Munster, Germany
Aim In patients (pls) with moderate and severe aortic valve stenosis (AS), the presence of clinical signs and symptoms, reduced ejection fraction and concomitant
coronary artery disease (CAD) have been associated with an adverse outcome.
The prognostic impact el renal failure and diabetes mellitus as compared to those
factors has not been elucidated.
Methods Seventy-four pls with moderate or severe AS (mean aortic valve area
0.94-0.3 cn~, 39 with concomitant CAD, mean age 694-11 years) were prospectively enrolled. The baseline glomerular filtration rate (GFR) was calculated using
Eur J Echocardiography Abstracts Supplement, December 2005
the Cockrofl Gaull equation. Diabetes mellitus was diagnosed according to WHO
criteria. Echo measurements included lelt ventricular (LV) dimensionsNolumes,
muscle mass, ejection fraction, milral E/A ratio, deceleration time and tissue
Doppler analysis el mitral annular velocities (S', E', A'). Death from a cardiac cause
was defined as study endpoint.
Results During a follow-up el 4544-356 days, 54 pls underwent aortic valve replacement (28 with concomitant coronary artery bypass grafting), and 11 pts suflered a cardiac death. Survivors and non-survivors did not differ with respect to
aortic valve area, clinical signs and symptoms, presence of concomitant CAD, muscle mass or indices el LV systolic/diastolic lunction. Non-survivors were older, had
a higher mitral E/E'-ralio, a lower GFR (37.94-14.7 ml/min vs. 58.94-93.0 ml/min,
p=0.004) and a higher prevalence el diabetes mellitus (31.8% vs. 8.0O/0, p=0.01).
Stepwise mullivariable Cox regression analysis identified a GFR < 39 ml/min (Relative risk 9.16, 95% CI 2.75-30.57, p<0.001 ) and diabetes mellilus (RR: 3.97, 95%
CI 1.29-12.2, p=0.01) as independent predictors of cardiac death. In pls with GFR
< 39 ml/min, outcome was markedly poorer as compared with to pls with GFR >
39 ml/min (evenl-lree survival rate 25.3% vs. 93.6%, p<0.001 ).
Conclusions: In pls with moderate to severe AS, renal failure and diabetes mellilus are stronger predictors of adverse outcome than clinical signs and symptoms,
impairment el LV systolic lunction or concomitant CAD.
546
Plasma levels of peripheral inflammatory markers are associated with
the mgrsssion of left ventricular stiffness a t e r valve replacement for
aortic stenosis
S. Kastellanos 1, K. Aggeli 2, S. Castellanos 3, d. Parissis 3, C. Chrysochoou 2,
D. Panagiolakos 1, S. Zezas 2 , D. Kremastinos 3.1Athens " Greece; 2University of
Athens, 1st Card. Dep. Hippokration Hospital, Athens, Greece; 3University of
Athens Attikon Hospital, Second Cardiology Department, Athens, Greece
Background: The progression of aortic valve stenosis (AVS) has been associated with a low grade inflammatory process concerning the activation of proinflammatory and chemolaclic cylokines. This study investigates the relationship
of representative plasma inflammatory markers [high sensitive (hs) CRP, TNF-a,
MCP-1] with the regression el left venlricular (LV) hypertrophy and stiffness (LVB)
after valve replacement of AVS.
Methods: Forty-three patients (27 men, mean age: 654-12; 16 women, mean age:
694-7 years) underwent valve replacement lot AVS, and plasma inflammatory mediators were measured at baseline and 10 days, 3 and 6-months pest-operatively
using nephelometry (hsCRP: Dale Bering) and ELIBA assays (TNF-a, MCP-1 : HyCull Biotechnology Holland). LV mass (Penn convention) and LVS [(0.07/DecE)2]
were echocardiographically determined at the same time intervals.
Resells: Plasma levels of inflammatory mediators and echocardiographic measurements are summarized in the Table. A significant decrease el hsCRP, TNF-a
and MCP-1 as well as a regression el LVS was observed over the 6-month postoperative lollow-up. Multiple regression analysis showed that values el bsCRP,
TNF-a, and MCP-1 at 3 and 6 months post-operatively were inversely correlated wilh LVS (bsCRP/3monlhs: -1.12, p=0.05, 6 months: -1.15, p=0.05; TNF-aJ3
months: -1.15, p=0.035, 6 months: -1.17, p=0.05; MCP-1/3 months: -1.11, p=0.04,
6 months: -1.10, p=0.05). Finally, no correlations were lound between the various
inflammatory markers and the reduction el LV mass post-operatively.
Table
Baseline
Post-10days P0st-3months Post-6 months P for trend
hsCRP (ng/ml) 15084-13
52724-41
6.994-4.9
5.594-3.9
0.03
TNF-a (pg/ml)
211 294-129
135.794-29 13624-277
464-10.28
0028
MCP-I (pg/ml)
1484-40 125954-15.15 53.574-1256
28.384-6.15
0.02
LVS (mmHg/ml) 0.14-006
0.134-0.07 0.094-0.05 0.094-0.07
0.05
LV mass
2914-36
2794-43
2534-39
2384-40
0.18
Conclusions: Plasma pro-inflammatory and chemotactic molecules are associated with the regression of LVS after valve replacement in AVB patients, suggesting
thal abnormal immune responses are implicated in the palhophysiology of cardiac
abnormalities during severe AVS.
547
Nt-pro-BNP plasma levels are associated with temporal changes of early
colour M-Mode flow propagation a t e r aortic valve replacement
S. Kastellanos 1, S. Castellanos 2, J. Parissis 2 , K. Aggeli 3, C. Chrysochoou 3,
D. Panagiotakos 1, T. Psarres 4 , D. Kremaslines 2 . 1Athens, Greece; eUniversity of
Athens Attikon Hospital, Second Cardiology Department, Athens, Greece;
3University of Athens, tst Card. Dep. Hippokration Hospital, Athens, Greece;
4Hippokration General Hospital, Cardiosurgery Department, Athens, Greece
Inlroduction: Early color M-Mode flow propagation (FP) has been suggested as a
useful marker of left ventricular (LV) diastolic function. Elevated NT- pro-BNP levels
may also reflect elevated LV filling pressures. This study investigates the possible
relationship el pro-BNP plasma levels with FP before and alter aortic valve replacement (AVR) in patients with severe aortic valve stenesis (AVB) and preserved LV
systolic function.
Methods: During 2002, we studied 43 patients who underwent valve replacement
lor severe AVS (27 men, mean age: 654-12 years and 16 women, mean age: 694-7
years). Patients with an ejection #action <50% were e~cluded. FP was measured
by echocardiography pre-operatively and 10 days, 3 and 6 months after surgery.
Abstracts
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Finally, NT-pro-BNP plasma levels were also measured at the same time intervals,
using an ELISA assay.
Results: FP values showed a parabolic course during the period ol our study
(41.89+13, 4026±15.3, 45.83±19.7 and 51.31+95cm/sec belore AVR, 10 days,
3 and 6 months alter surgery respectively, p=O.04), while N]--pro-BNP levels presented an inverse parabolic course (284+47,4, 298±36,8, 233,7±61,4, 172,5±65
fmol/ml belore AVR, 10 days, 3 and 6 months after surgery respectively, p=0.045).
Statistical analysis showed that FP values and NT-pro-BNP levels were inversely
correlated after AVR (-1,12with p=0,045, -1,19with p=0,035 and -1,21 with p=O,05,
10 days, ,3 and 6 months alter surgery respectively).
Conclusions: NT-pro-BNP levels are inversely related to FP values alter AVR. ]-he
inverse course of these markers seems to reflect the progression ol lell venlricular
diastolic lunction in patients alter AVR (temporary increase and gradual regression
of lelt ventricular stillness).
Eur J Echocardiography Abstracts Supplement, December 2005