Objectives-To examine long axis excursion in patients with all grades of ao
rtic stenosis and preserved transverse systolic function, and to compare lo
ng axis excursion in symptomatic with that in asymptomatic severe aortic st
enosis.
Design-Prospective comparative study.
Setting-Regional cardiothoracic centre.
Patients-78 patients with all grades of aortic stenosis and normal fraction
al shortening and ejection fraction were studied. There were two comparison
groups, 10 age matched normal subjects and 14 patients with aortic stenosi
s and fractional shortening < 26%.
Methods-Aortic valve function and left ventricular mass were assessed echoc
ardiographically. M mode measurements of long axis excursion at the septal
and lateral sides of the mitral annulus were taken.
Results-There were significant differences between the groups in long axis
excursion at both the septal (p < 0.0001) and lateral sides of the mitral a
nnulus (p = 0.002 by analysis of variance). Long axis excursion was indepen
dently related to both left ventricular mass index (p = 0.001) and the grad
e of aortic stenosis (p = 0.002). Comparing patients with severe aortic ste
nosis with and without symptoms, there were significant differences in effe
ctive orifice area (p = 0.02) and long axis excursion at the lateral side o
f the mitral annulus (p = 0.04), but not in fractional shortening, ejection
fraction, or peak or mean pressure difference.
Conclusion-In patients with aortic stenosis, long axis excursion is reduced
even in the presence of normal fractional shortening or ejection fraction.
It is lower in patients with symptomatic compared with asymptomatic severe
aortic stenosis and may be of use in predicting the onset of symptoms.