Peak left ventricular pressure during percutaneous aortic balloon valvuloplasty: Clinical and echocardiographic correlations

• Published in: Journal of the American College of Cardiology 1989-07, Vol.14 (1), p.135-142
• Main Authors: Bittl, John A., Bhatia, Satinder J.S., Plappert, Ted, Ganz, Peter, Sutton, Martin G.St John, Selwyn, Andrew P.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - therapy; Biological and medical sciences; Cardiology. Vascular system; Catheterization - adverse effects; Catheterization - methods; Echocardiography; Endocardial and cardiac valvular diseases; Female; Heart; Heart - physiopathology; Heart Failure - complications; Heart Failure - physiopathology; Heart Ventricles - physiopathology; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Monitoring, Physiologic - methods; Pressure
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(89)90063-6

Peak left ventricular pressure during balloon inflation was measured in 20 patients who underwent balloon valvuloplasty for severe aortic stenosis to define the determinants of ventricular pressure development in response to increased loading conditions. The peak left ventricular pressure ranged from 150 ± 5 to 386 ± 22 mm Hg (mean ± Sl), was reproducible in each patient with each balloon inflation (mean coefficient of variation 7.8%) and correlated with concurrent echocardiographic measurements of ejection fraction (r = 0.89, p = 0.0001) and mass/volume ratio in systole (r = 0.91, p = 0.0001) or diastole (r = 0.88, p = 0.0001). Thirteen patients with class II or more severe congestive heart failure had lower values for peak left ventricular pressure than did those without failure (225 ± 46 versus 305 ± 45 mm Hg, p = 0.002), whereas no difference in rest left ventricular systolic pressure was seen between the two groups. The measurement of peak left ventricular pressure was inversely related to rest mean circumferential end-systolic wall stress (r = 0.52, p = 0.046). Thus, peak left ventricular systolic pressure measured during aortic valvuloplasty in humans correlates closely with traditional measures of left ventricular function. This measurement, which previously has been obtained only in experimental animal studies, is a simple and reproducible hemodynamic index that may provide new insights in studies of ventricular function and congestive heart failure in aortic stenosis.