Changes in left ventricular diastolic performance after aortic balloon valvuloplasty: Acute and late effects

• Published in: Journal of the American College of Cardiology 1990-10, Vol.16 (4), p.795-803
• Main Authors: Sheikh, Khalid H., Davidson, Charles J., Honan, Michael B., Skelton, Thomas N., Kisslo, Kathernine B., Bashore, Thomas M.
• Format: Article
• Language: English
• Subjects: Aged; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - therapy; Cardiac Catheterization; Catheterization; Diastole - physiology; Echocardiography; Female; Follow-Up Studies; Gated Blood-Pool Imaging; Heart - diagnostic imaging; Humans; Male; Time Factors; Ventricular Function, Left - physiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(10)80324-9

To evaluate acute and follow-up changes in left ventricular diastolic performance, simultaneous digital left ventriculography and micromanometry were performed in 49 patients undergoing aortic balloon valvuloplasty. All patients improved symptomatically after valvuloplasty, and 26 returned 6.3 ± 1.5 months later for follow-up catheterization. Immediately after valvuloplasty, aortic valve area increased (before 0.5 ± 0.2 versus after 0.8 ± 0.2 cm2, p < 0.01), cardiac output (before 4.3 ± 1.2 versus after 4.4 ± 1.3 liters/min) and ejection fraction (before 51 ± 18% versus after 52 ± 17%) did not change and diastolic indexes worsened, signified by a decrease in peak filling rate (before 247 ± 80 versus after 226 ± 78 ml/s, p < 0.01) and increase in the time constant of isovolumetric relaxation (π) (before 78 ± 29 versus after 96 ± 40 ms, p < 0.01) and the modulus of chamber stiffness (before 0.107 ± 0.071 versus after 0.141 ± 0.083, p < 0.01). At follow-up catheterization, 16 patients continued to have symptomatic improvement (group 1) and 10 had recurrence of symptoms (group 2). Aortic valve area, cardiac output and ejection fraction at follow-up catheterization in both groups were similar and unchanged from values before valvuloplasty. However, diastolic indexes and left ventricular mass were improved compared with values before valvuloplasty in group 1 and worse in group 2 as follows: peak filling rate: group 1 ±8% versus group 2 −20%, p = 0.001; time constant of isovolumetric relaxation: group 1 −11% versus group 2 ±35%, p = 0.008; chamber stiffness: group 1 −27% versus group 2 ±26%, p = 0.001; mass: group 1 −9% versus group 2 ±6%, p = 0.004. These data indicate that 1) diastolic performance worsens immediately after valvuloplasty, consistent with the development of ischemia during balloon inflation; and 2) changes in left ventricular diastolic indexes and mass, rather than aortic valve area or systolic indexes, correlate best with symptomatic status 6 months after valvuloplasty.