Jegadeesh, J (2014) Clinical and Echocardiographic Correlates of Valvulo-Arterial Impedance in Aortic Stenosis with focus on Asymptomatic Aortic Stenosis. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Aortic Stenosis is one of the major causes of cardiovascular morbidity and mortality in the elderly. It is the most common causes for valve surgery in the developed countries. In recent times aortic stenosis is believed to be due to atherosclerotic process affecting the valves along with the great arteries hence aortic valve disease is also considered to be an abnormality of the valve and arterial system together. In India, the incidence of isolated aortic valve disease has been increasing and many cases of isolated aortic valve disease is being diagnosed due to better utilization of healthcare facilities by people and due to the decline in the incidence of rheumatic heart disease. In this scenario we thought that it would be prudent to have a study on the valvuloarterial impedance in our south Indian population so as to get information regarding the pattern of global LV load in our subset of patients with Aortic stenosis and to study the relationship of valvuloarterial impedance to patients symptoms and indices of LV function and geometry. Since asymptomatic patients with severe aortic stenosis and high LV global load had a poor prognosis estimation of valvuloarterial impedance in this population would help in risk stratification and direct them towards early surgery thereby reducing adverse event rate. AIMS AND OBJECTIVES : 1. To study the valvuloarterial impedance levels in south Indian population presenting with isolated Aortic valve disease. 2. To study the correlation of symptoms of Aortic stenosis with levels of valvuloarterial impedance 3. To evaluate the relationship between Age, Sex, Body mass index and Hypertension and valvuloarterial impedance in patients with Aortic stenosis. 4. To study the correlation of indices of Left Ventricular geometry and Left Ventricular function (systolic, diastolic and global) with levels of valvuloarterial impedance 5. To evaluate the relationship between mitral annular plane systolic excursion and levels of valvuloarterial impedance in aortic stenosis patients with normal Ejection fraction, and to unmask early Left Ventricular longitudinal dysfunction. 6. To compare the indices of Aortic stenosis severity to levels of valvuloarterial impedance. 7. To evaluate the Doppler echocardiographic characteristics of patients with asymptomatic Aortic stenosis. CONCLUSIONS : Among the symptoms of Aortic stenosis, only Syncope had significant association with high levels of valvuloarterial impedance. Older patients with aortic stenosis had significantly higher valvuloarterial impedance values due to a less compliant arterial system. In patients with Aortic stenosis higher systolic blood pressure and pulse pressure had a significant association with high levels of valvuloarterial impedance. The patients with high levels of valvuloarterial impedance had significantly altered LV geometry as evidenced by thicker ventricles and smaller LV cavity dimensions. There was no significant difference in LV systolic function indices between the lower and higher valvuloarterial impedance groups. All the patients in this study group had LV diastolic dysfunction and higher grades of diastolic dysfunction were seen in patients with high valvuloarterial impedance levels. The Mitral annular plane systolic excursion (MAPSE) was significantly decreased in patients with patients with higher levels of valvuloarterial impedance suggesting the presence of intrinsic myocardial longitudinal dysfunction in spite of preserved LV ejection fraction. There was a significant correlation between higher valvuloarterial impedance levels and lower aortic valve area and higher aortic valve peak gradients. There were no significant differences between Doppler characteristics between asymptomatic and symptomatic patients with aortic stenosis except for LV ejection fraction which was higher in the asymptomatic group.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical and Echocardiographic Correlates of Valvulo-Arterial Impedance in Aortic Stenosis with focus on Asymptomatic Aortic Stenosis. |
| Subjects: | MEDICAL > Cardiology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 05 Jul 2017 23:40 |
| Last Modified: | 06 Jul 2017 09:42 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1045 |
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