Assessment of cardiac synchrony and segmental systolic and diastolic functions by tissue doppler imaging in patients with aortic valve sclerosis

Aortic valve sclerosis (AVS) may be associated with increased cardiovascular risk and mortality. In this study, we aimed to evaluate the systolic and diastolic functions of the left ventricle and the status of cardiac synchronization in patients with AVS but no clinical evidence of systolic or diastolic dysfunction by using tissue Doppler imaging (TDI). Thirty people with AVS and 30 age and sex matched healthy volunteers were enrolled. Global cardiac function was assessed by the measurement of left ventricular ejection fraction, mitral e and a velocities and mitral E/e` ratio. Segmental myocardial systolic (Sm), early diastolic (Em) and late diastolic (Am) peak velocities were measured at one right (lateral) and 5 different left ventricular myocardial segments by using Tissue Doppler Imaging (TDI). Precontraction time (Q-Sm), defined as the time interval between the beginning of the QRS complex on the surface ECG and the beginning of the systolic wave (Sm) on TDI, was used to evaluate cardiac synchrony. Intraventricular systolic synchrony was assessed by the difference between Q-Sm intervals acquired at 5 different left ventricular segments. Interventricular activation delay was defined as the difference between the right ventricular lateral wall Q-Sm and the Q-Sm at the latest activated left ventricular myocardial segment. The peak Sm velocity at the lateral left ventricular wall was significantly lower in patients with AVS as compared to controls (7.22±1.47 cm/sec vs 8.13±1.63 cm/sec, p=0.028). The peak early diastolic velocities (Em) at the septum(7,67±2,29 cm/sec vs 8,88±2,01 cm/sec), left ventricular lateral (8,78±1,77 cm/sec vs 9,85±2,34 cm/sec) and posterior walls(8,58±2,47 cm/sec vs 11,29±3,27) were significantly lower in the patient group (p=0.036, p=0.043, p=0.001, respectively). Inter and intraventricular delay were significantly longer in patients with AVS as compared to controls (23,13±17,61 vs 6,43±5,96 msec; p=0,0001 and 26,8±16,82 vs 9,56±4,7 msec; p=0,0001, respectively). There was no correlation between the indices of cardiac synchrony (inter and intraventricular delay) and mitral E/A ratio, LV mass, age and the presence of hypertension, diabetes mellitus or dyslipidemia. On the contrary, these indices were found to be negatively correlated with left ventricular lateral peak Sm velocity and Em/Am ratios acquired at the left ventricular lateral and anterior walls and the right ventricular lateral wall.In conclusion, in patients with AVS and normal global cardiac functions, TDI may disclose segmental systolic and diastolic dysfunction and impaired cardiac synchrony as compared to controls. The clinical significance of these findings need to be validated by further research.Keywords: Aortic valve sclerosis, Tissue Doppler imaging, dyssynchronization