Aortic valve stenosis: Comparison of patients with to those without chronic congestive heart failure

Abstract

Eighty-four patients with aortic valve stenosis (AS) and without other valvular or coronary artery disease were studied to investigate the pathophysiologic importance of hemodynamic and functional factors in the development of congestive heart failure (CHF). Thirty had clinical and radiographic signs of CHF. There was no significant difference between patients with and those without CHF in aortic valve index (0.26 ± 0.09 vs 0.34 ± 0.16 cm 2/m 2), mean aortic valve gradient (64 ± 19 vs 59 ± 25 mm Hg), left ventricular (LV) systolic pressure (201 ± 31 vs 201 ± 35 mm Hg), LV enddiastolic diameter (4.8 ± 1.0 vs 4.4 ± 0.7 cm) or posterior LV wall thickness (14.0 ± 4.7 vs 15.0 ± 30.0 mm). Patients with CHF had higher LV end-diastolic pressure (22 ± 10 vs 16 ± 7 mm Hg, p < 0.005) and LV wall stress (370 ± 138 vs 300 ± 69 g/cm 2, p < 0.005) and lower cardiac index (2.0 ± 0.5 vs 2.4 ± 0.6 liters/min/m 2, p < 0.005) and LV ejection fraction (55 ± 18 vs 68 ± 13%, p < 0.0005). An inverse linear relation (r = −0.59, p < 0.01) was present between LV wall stress and LV ejection fraction such that as stress increased, LV ejection fraction fell. Values for both LV wall stress and LV ejection fraction overlapped considerably between the groups and, more important, only 40% of patients with CHF had a depressed LV ejection fraction. Most patients with CHF had normal LV systolic function, and in these patients CHF was most likely a result of abnormal diastolic compliance. These findings suggest that patients with AS and CHF are not a homogenous group, and call attention to the importance of diastolic dysfunction and systolic dysfunction owing to increased LV wall stress as major factors responsible for CHF.