ALTERATIONS IN LEFT-VENTRICULAR DIASTOLIC FILLING PATTERNS ALTER AORTIC-VALVE REPLACEMENT IN PATIENTS WITH AORTIC-STENOSIS - RELATION TO FUNCTIONAL CLASS

To determine the changes in left ventricular diastolic filling velocit y profiles after aortic valve replacement and their relation to clinic al functional status, 48 consecutive patients with severe aortic steno sis underwent preoperative cardiac catheterization and Doppler echocar diographic assessment before and 3 months after surgery. The patients were divided into two groups according to the functional class. Group I included 15 patients in New York Heart Association functional class I or II, and group II consisted of 33 patients in functional class III or IV, Before the operation, the left ventricular peak early filling velocity was higher, and the later atrial filling velocity was lower i n group II than in group I, The ratio early/late filling velocities wa s higher and the deceleration time was shorter in group II patients. F or overall 48 patients, the Doppler-derived left ventricular filling v ariables correlated significantly with functional class, pulmonary art ery pressure, and left ventricular systolic function. After aortic val ve replacement, early filling velocity (71 +/- 22 vs. 85 +/- 22 cm/s; p < 0.001) and early-to-late filling velocity ratio (0.70 +/- 0.14 vs. 0.88 +/- 0.23; p < 0.001) increased in group I, but decreased in grou p II (early filling velocity 92 +/- 26 vs. 80 +/- 25 cm/s; early-to-la te filling velocity ratio 1.60 +/- 0.90 vs. 0.90 F 0.30; all p < 0.001 ). The improvement in functional class was closely related to changes in early-to-late filling velocity ratio (p < 0.02), but did not correl ate with myocardial mass regression and changes in left ventricular sy stolic function. This prospective study indicates that left ventricula r diastolic filling is often impaired in patients with aortic stenosis and contributes to the reduced functional capacity. Aortic valve repl acement alters favorably the left ventricular diastolic function and, therefore, the patients' symptomatology.