Utility value of tissue doppler in Aortic stenosis; E/EA values predict symptoms and functional capacity in patients with Aortic stenosis.

Aortic stenosis (AS) continues to be an important valvular heart disease that leads to significant morbidity and mortality. The natural history of aortic stenosis is limited by onset of left ventricular systolic dysfunction. Nowadays the importance of identifying diastolic dysfunction in patients with aortic stenosis is being recognized since it contributes significantly to the onset of symptoms and prognosis. Left ventricular (LV) hypertrophy is an adaptive process that compensates for pressure overload associated with aortic stenosis and is responsible for changes in systolic and diastolic functions. This process is accompanied by a remodeling of the LV that involves the muscular and non muscular compartments of the ventricle. As a result of this remodeling process, muscle fiber hypertrophy and abnormalities of the collagen network occur that are responsible for changes in systolic and diastolic functions. Although it has been previously shown that aortic valve replacement may lead to immediate hemodynamic improvement and to prolongation of survival, it has been reported that regression of myocardial hypertrophy after relief of the hemodynamic burden is a process that may continue for decades after valve replacement. However, abnormal exercise hemodynamics may persist late after valve replacement despite a normal systolic function, suggesting impaired diastolic function in these patients. LV systolic function may be normal in the presence of advanced diastolic dysfunction in aortic stenosis. Patients with aortic stenosis develop variable grades of diastolic dysfunction even before the onset of symptoms. AIM OF THE STUDY: To find out the tissue doppler derived E/Ea values in patients with moderate and severe aortic stenosis. To assess the presence of diastolic dysfunction in patients with aortic stenosis. To find out the relationship between the E/Ea values and presence of symptoms in patients with AS. To correlate the six minute walk distance to E/Ea values in patients with moderate and severe AS. To find out the relationship between various diastolic indices and symptoms in patients with AS. CONCLUSIONS: 1. Diastolic dysfunction develops in patients with aortic stenosis even in the presence of normal left ventricular systolic function. 2. E/Ea ratio is elevated in symptomatic patients with aortic stenosis. 3. Among diastolic parameters increased E/Ea ratio correlates with severity of symptoms. 4. E/Ea ratio has highly significant inverse correlation and Ea velocity has direct correlation with functional capacity. 5. TDI derived E/Ea ratio could be an early marker for aortic valve replacement in asymptomatic patients with severe aortic stenosis