Left ventricular diastolic function and myocardial fibrosis value to the development of pulmonary hypertension in patients with severe aortic stenosis

Aim: To evaluate left ventricular (LV) diastolic function and myocardial fibrosis value for pulmonary hypertension (PH) development in patients with severe aortic stenosis (AS). Objectives: To evaluate LV diastolic function and systolic pulmonary artery pressure (PAPs) by 2D-echocardiography for patients with severe AS. To analyze interstitial myocardial fibrosis in microscopic images for patients with severe AS. To assess LV diastolic function and myocardial fibrosis correlation with PAPs. Patients and methods: During 2014-2016 years prospective study we evaluated 33 patients, who underwent aortic valve replacement, because of severe AS and myocardial biopsy was taken. 2D-echocardiography was performed before surgery. Patients were divided into two groups by PSP: group I - without PH (n = 12), group II – with PH (n = 21), (PAPs>35mmHg). Statistical analysis was performed using Microsoft Excel and ,,SPSS for Windows 23.0” programs. We used Mann-Whitney test, Spearman correlation coefficient. The estimated median and quartiles. The difference was significant when p 0,05). Patients with PH had higher left ventricle end-diastolic diameter index (LVEDDi) (26 vs. 22 mm/m2, p=0.001), left ventricular mass index (LVMMi) (137 vs. 95,8 g/m2, p=0.006). Left ventricular ejection fraction (LVEF) between the groups did not differ (p>0.05). E/E‘ratio (13.8 vs. 10.2, p=0.02) and myocardial fibrosis in cross sections (19.3% vs. 8.5%, p = 0.005) was significantly higher in pts with PH. Interstitial myocardial fibrosis in cross sections correlated with LVEDDi (R= 0.497, p = 0.004), LVMMi (R= 0.533, p = 0.003), E/E' (R= 0.497, p = 0.004), left atrial (LA) diameter (R=0,378, p=0,036) and systolic PAPs (R = 0.377, p = 0.037). Conclusion: LV atrium was more dilated, also, LV mass index and E/E’ ratio was higer in pts with severe AoS and PH. In group II myocardial fibrosis expression was higher in cross sections. Expression of interstitial myocardial fibrosis in cross sections correlated with diastolic function parameters (E/E' ratio, LA diameter) and systolic PAPs (R = 0.377, p = 0.037). Recommendations: LV diastolic function monitoring would allow to predict the development of myocardial fibrosis and pulmonary hypertension progression, in patients with AS