M-MODE ECHOCARDIOGRAPHY IN AORTIC-STENOSIS

To relate preoperative findings at M-mode echocardiography to preopera tive clinical and haemodynamic status and to identify possible echocar diographic risk factors for mortality after aortic valve replacement ( AVR), 250 patients with AVR for aortic stenosis (AS) were studied. In follow-up averaging 3.2 years there were 22 early (< 30 days) and 23 l ate deaths. Rising NYHA function class and cardiothoracic index, and l eft ventricular (LV) failure were related to rising LV end-diastolic a nd end-systolic diameter index (EDDI, ESDI), and to increasing LV musc le mass index and decreasing fractional shortening (FS). High peak-to- peak systolic aortic valve gradient and LV end systolic pressure were related to small dimensions of LV with increased FS and posterior wall thickness (PWTh). EDDI less than or equal to 20 mm/m(2) and increasin g PWTh were independent risk factors for early mortality. Patients wit h EDDI less than or equal to 20 mm/m had normal or supranormal FS. PWT h was the only independent risk factor in long-term survival: 5-year r ates being 81 +/- 6%, 94 +/- 3% and 85 +/- 7% for PWTh less than or eq ual to 13, 14-17 and greater than or equal to 18 mm, respectively (p = 0.03). Prevalence of concomitant coronary artery disease (CAD) rose w ith decreasing PWTh. Angina pectoris in non-CAD patients was related t o very high PWTh. Subnormal EDDI was associated with poor surgical out come, and dilated, poorly contracting LV with congestive heart failure prior to AVR. The degree of LV hypertrophy seemed to be the dominant risk factor, but confounders included myocardial ischaemia due to CAD in low-grade hypertrophy or to hypertrophy per se. A hypothetically co nfounding factor is the reversibility potential of moderate or severe LV hypertrophy following AVR.