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Aortic Outflow Doppler Trace – The Relation Between Left Ventricular Function, Increased Afterload and Trace Symmetry.

Objective: Doppler traces provide reliable data on ventricular function based on haemodynamic parameters. In LV failure, the Doppler trace of aortic flow often shows lower velocities with a slower increase in velocity, a more rounded curve form and the peak velocity occurring later in systole. In aortic stenosis, it has been suggested that peaking of the aortic velocity profile occurs later in systole with higher grade stenoses. Outflow velocities represent the pressure gradient between the LV and aorta and thus are influenced by either of them. We assumed a relationship between the symmetry of aortic outflow velocities, myocardial function and aortic valve stenosis severity. Methods: 60 patients (pts.) underwent a full echocardiography study and were divided in 2 subgroups: group A consisted of 33 pts. with aortic valve stenosis (21 male, 12 female, mean age 64.9&#177; 13.6 years), while group B consisted of 27 healthy volunteers with no signs or symptoms of cardiovascular disease (10 male, 17 female, mean age 53.6&#177; 11.7 years). Time from onset of aortic flow to peak velocity (T1) and time from peak aortic flow velocity to aortic valve closure (T2) were measured. Results: T2/T1 was lower in group A (2.05&#177; 0.66 vs. 2.80&#177; 0.58, p<0.005), as well as ejection fraction (EF=61.1&#177; 11.5% vs. 68.6&#177; 5.8%, p<0.005). LVIDd was greater in group A (5.3&#177; 0.8 cm vs. 4.8&#177; 0.4 cm, p<0.01). PG max=81.1&#177; 31.4 mmHg, 6.8&#177; 3.3 mmHg, p<0.005, group A and B, respectively ; PG mean=49.0&#177; 17.8 mmHg, 3.4&#177; 1.6 mmHg, p<0.005, group A and B, respectively. A negative correlation was present between PG max and T2/T1 (r=-0, 66), PG mean and T2/T1 (r=-0, 69) and a positive correlation between EF and T2/T1 (r=0, 64) (Figure 1). Conclusion: The results show a significant tendency towards more symmetric Doppler traces in patients with aortic stenosis. Furthermore, the results suggest that the Doppler trace symmetry is also related to a reduction in EF and might be a result of compensatory prolongation in force development. Aortic trace symmetry which is easily assessed by Doppler echocardiography might provide more data on reduced LV function in severe aortic stenosis.

Doppler echocardiography; aortic strenosis; aortic outflow profile; ventricular afterload; contractile function

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