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. 2001 Jul;86(1):52–56. doi: 10.1136/heart.86.1.52

Long axis excursion in aortic stenosis

S Takeda 1, H Rimington 1, N Smeeton 1, J Chambers 1
PMCID: PMC1729828  PMID: 11410562

Abstract

OBJECTIVES—To examine long axis excursion in patients with all grades of aortic stenosis and preserved transverse systolic function, and to compare long axis excursion in symptomatic with that in asymptomatic severe aortic stenosis.
DESIGN—Prospective comparative study.
SETTING—Regional cardiothoracic centre.
PATIENTS—78 patients with all grades of aortic stenosis and normal fractional shortening and ejection fraction were studied. There were two comparison groups, 10 age matched normal subjects and 14 patients with aortic stenosis and fractional shortening < 26%.
METHODS—Aortic valve function and left ventricular mass were assessed echocardiographically. 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 annulus (p = 0.002 by analysis of variance). Long axis excursion was independently related to both left ventricular mass index (p = 0.001) and the grade of aortic stenosis (p = 0.002). Comparing patients with severe aortic stenosis with and without symptoms, there were significant differences in effective orifice area (p = 0.02 ) and long axis excursion at the lateral side of 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.


Keywords: aortic stenosis; long axis excursion; symptoms

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Figure 1  .

Figure 1  

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Long axis excursion (mean and 95% confidence interval) for all grades of aortic stenosis and the two comparison groups. FS, fractional shortening

Figure 2  .

Figure 2  

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Linear regression for septal excursion of the mitral annulus (cm) and left ventricular mass index (LVMI) (g/m2).

Figure 3  .

Figure 3  

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Long axis excursion at septal and lateral sides of the mitral annulus. The mean and 95% confidence intervals are shown.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alam M., Höglund C., Thorstrand C., Philip A. Atrioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction. J Intern Med. 1990 Dec;228(6):569–575. doi: 10.1111/j.1365-2796.1990.tb00281.x. [DOI] [PubMed] [Google Scholar]
  2. Brener S. J., Duffy C. I., Thomas J. D., Stewart W. J. Progression of aortic stenosis in 394 patients: relation to changes in myocardial and mitral valve dysfunction. J Am Coll Cardiol. 1995 Feb;25(2):305–310. doi: 10.1016/0735-1097(94)00406-g. [DOI] [PubMed] [Google Scholar]
  3. Choy A. M., Darbar D., Lang C. C., Pringle T. H., McNeill G. P., Kennedy N. S., Struthers A. D. Detection of left ventricular dysfunction after acute myocardial infarction: comparison of clinical, echocardiographic, and neurohormonal methods. Br Heart J. 1994 Jul;72(1):16–22. doi: 10.1136/hrt.72.1.16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Connolly H. M., Oh J. K., Orszulak T. A., Osborn S. L., Roger V. L., Hodge D. O., Bailey K. R., Seward J. B., Tajik A. J. Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation. 1997 May 20;95(10):2395–2400. doi: 10.1161/01.cir.95.10.2395. [DOI] [PubMed] [Google Scholar]
  5. Henein M. Y., Gibson D. G. Abnormal subendocardial function in restrictive left ventricular disease. Br Heart J. 1994 Sep;72(3):237–242. doi: 10.1136/hrt.72.3.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Henein M. Y., Gibson D. G. Suppression of left ventricular early diastolic filling by long axis asynchrony. Br Heart J. 1995 Feb;73(2):151–157. doi: 10.1136/hrt.73.2.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Henein M. Y., Priestley K., Davarashvili T., Buller N., Gibson D. G. Early changes in left ventricular subendocardial function after successful coronary angioplasty. Br Heart J. 1993 Jun;69(6):501–506. doi: 10.1136/hrt.69.6.501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hwang M. H., Hammermeister K. E., Oprian C., Henderson W., Bousvaros G., Wong M., Miller D. C., Folland E., Sethi G. Preoperative identification of patients likely to have left ventricular dysfunction after aortic valve replacement. Participants in the Veterans Administration Cooperative Study on Valvular Heart Disease. Circulation. 1989 Sep;80(3 Pt 1):I65–I76. [PubMed] [Google Scholar]
  9. Jones C. J., Raposo L., Gibson D. G. Functional importance of the long axis dynamics of the human left ventricle. Br Heart J. 1990 Apr;63(4):215–220. doi: 10.1136/hrt.63.4.215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kennedy K. D., Nishimura R. A., Holmes D. R., Jr, Bailey K. R. Natural history of moderate aortic stenosis. J Am Coll Cardiol. 1991 Feb;17(2):313–319. doi: 10.1016/s0735-1097(10)80092-0. [DOI] [PubMed] [Google Scholar]
  11. Krayenbuehl H. P., Hess O. M., Monrad E. S., Schneider J., Mall G., Turina M. Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement. Circulation. 1989 Apr;79(4):744–755. doi: 10.1161/01.cir.79.4.744. [DOI] [PubMed] [Google Scholar]
  12. Lindblom D., Lindblom U., Qvist J., Lundström H. Long-term relative survival rates after heart valve replacement. J Am Coll Cardiol. 1990 Mar 1;15(3):566–573. doi: 10.1016/0735-1097(90)90627-2. [DOI] [PubMed] [Google Scholar]
  13. Lund O., Nielsen T. T., Emmertsen K., Flø C., Rasmussen B., Jensen F. T., Pilegaard H. K., Kristensen L. H., Hansen O. K. Mortality and worsening of prognostic profile during waiting time for valve replacement in aortic stenosis. Thorac Cardiovasc Surg. 1996 Dec;44(6):289–295. doi: 10.1055/s-2007-1012039. [DOI] [PubMed] [Google Scholar]
  14. Marcus M. L., Doty D. B., Hiratzka L. F., Wright C. B., Eastham C. L. Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med. 1982 Nov 25;307(22):1362–1366. doi: 10.1056/NEJM198211253072202. [DOI] [PubMed] [Google Scholar]
  15. Omran H., Fehske W., Rabahieh R., Hagendorff A., Lüderitz B. Relation between symptoms and profiles of coronary artery blood flow velocities in patients with aortic valve stenosis: a study using transoesophageal Doppler echocardiography. Heart. 1996 Apr;75(4):377–383. doi: 10.1136/hrt.75.4.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Otto C. M., Burwash I. G., Legget M. E., Munt B. I., Fujioka M., Healy N. L., Kraft C. D., Miyake-Hull C. Y., Schwaegler R. G. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation. 1997 May 6;95(9):2262–2270. doi: 10.1161/01.cir.95.9.2262. [DOI] [PubMed] [Google Scholar]
  17. Pellikka P. A., Nishimura R. A., Bailey K. R., Tajik A. J. The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis. J Am Coll Cardiol. 1990 Apr;15(5):1012–1017. doi: 10.1016/0735-1097(90)90234-g. [DOI] [PubMed] [Google Scholar]
  18. Rediker D. E., Boucher C. A., Block P. C., Akins C. W., Buckley M. J., Fifer M. A. Degree of reversibility of left ventricular systolic dysfunction after aortic valve replacement for isolated aortic valve stenosis. Am J Cardiol. 1987 Jul 1;60(1):112–118. doi: 10.1016/0002-9149(87)90996-9. [DOI] [PubMed] [Google Scholar]
  19. Ross J., Jr Afterload mismatch in aortic and mitral valve disease: implications for surgical therapy. J Am Coll Cardiol. 1985 Apr;5(4):811–826. doi: 10.1016/s0735-1097(85)80418-6. [DOI] [PubMed] [Google Scholar]
  20. Ross J., Jr, Braunwald E. Aortic stenosis. Circulation. 1968 Jul;38(1 Suppl):61–67. doi: 10.1161/01.cir.38.1s5.v-61. [DOI] [PubMed] [Google Scholar]
  21. Sahn D. J., DeMaria A., Kisslo J., Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978 Dec;58(6):1072–1083. doi: 10.1161/01.cir.58.6.1072. [DOI] [PubMed] [Google Scholar]
  22. Schulman D. S., Remetz M. S., Elefteriades J., Frances C. K. Mild mitral insufficiency is a marker of impaired left ventricular performance in aortic stenosis. J Am Coll Cardiol. 1989 Mar 15;13(4):796–803. doi: 10.1016/0735-1097(89)90218-0. [DOI] [PubMed] [Google Scholar]
  23. Troy B. L., Pombo J., Rackley C. E. Measurement of left ventricular wall thickness and mass by echocardiography. Circulation. 1972 Mar;45(3):602–611. doi: 10.1161/01.cir.45.3.602. [DOI] [PubMed] [Google Scholar]
  24. Turina J., Hess O., Sepulcri F., Krayenbuehl H. P. Spontaneous course of aortic valve disease. Eur Heart J. 1987 May;8(5):471–483. doi: 10.1093/oxfordjournals.eurheartj.a062307. [DOI] [PubMed] [Google Scholar]
  25. Vaile J. C., Griffith M. J. Management of asymptomatic aortic stenosis: masterly inactivity but cat-like observation. Heart. 1997 Sep;78(3):215–217. doi: 10.1136/hrt.78.3.215. [DOI] [PMC free article] [PubMed] [Google Scholar]

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