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Echocardiographic assessment of atrioventricular plane displacement, Clinical application in patients with coronary artery disease, atrial fibrillation and aortic stenosis

Rydberg, Erik LU (2003)
Abstract (Swedish)
Popular Abstract in Swedish

Studier har visat att rörelsen i atrioventrikulära planet (AVPD) är korrelerat med såväl vänster kammares (VK) systoliska, mätt som ejections fraktion (EF), som diastoliska funktion. Ålder, hjärtfrekvens, VK storlek, vänster förmaks storlek, myokardiets tjocklek, kroppsyta och afterload är andra faktorer som påverkar AVPD. I denna avhandling studeras relationen mellan AVPD och utbredningen av kranskärlssjukdom, relationen mellan AVPD och graden av diastolisk fyllnadstörning samt relationen mellan AVPD och graden av aortastenos. Avhandlingen avser också att belysa huruvida AVPD har en prognostisk betydelse hos patienter med kranskärlssjukdom och hos patienter med förmaksflimmer. Studie I visar att... (More)
Popular Abstract in Swedish

Studier har visat att rörelsen i atrioventrikulära planet (AVPD) är korrelerat med såväl vänster kammares (VK) systoliska, mätt som ejections fraktion (EF), som diastoliska funktion. Ålder, hjärtfrekvens, VK storlek, vänster förmaks storlek, myokardiets tjocklek, kroppsyta och afterload är andra faktorer som påverkar AVPD. I denna avhandling studeras relationen mellan AVPD och utbredningen av kranskärlssjukdom, relationen mellan AVPD och graden av diastolisk fyllnadstörning samt relationen mellan AVPD och graden av aortastenos. Avhandlingen avser också att belysa huruvida AVPD har en prognostisk betydelse hos patienter med kranskärlssjukdom och hos patienter med förmaksflimmer. Studie I visar att AVPD är relaterat till grad och utbredning av kranskärlssjukdom oberoende av om patienten har haft hjärtinfarkt tidigare. Hos 159 patienter med stabil kranskärlssjukdom minskade AVPD med ju fler stenoser som patienten hade. Det är tidigare visat att AVPD och EF är olika metoder och olika mått på VK funktionen eftersom AVPD speglar både den systoliska och diastoliska funktionen, medan EF endast är ett mått på VK systoliska funktion. Fynden i studie II understryker detta. Studie II visade att AVPD var oberoende korrelerat med både VK systoliska och diastoliska funktion hos patienter med stabil kranskärlssjukdom. Ju sämre diastolisk fyllnad desto lägre AVPD. Det är visat i tidigare studier att AVPD har ett prognostiskt värde hos patienter med hjärtsvikt och hos patienter som haft hjärtinfarkt. Studie III och IV visade att AVPD även har ett prognostiskt värde gällande dödlighet hos patienter med stabil kranskärlssjukdom och hos patienter med kroniskt förmaksflimmer. Hos patienter med stabil kranskärlssjukdom var AVPD oberoende korrelerat till hjärtorsakad död. Relation mellan AVPD och dödlighet påvisades också hos patienter med förmaksflimmer. AVPD som prognostisk markör är dock begränsad i denna patientgrupp eftersom skillnaden i AVPD mellan de som avled i hjärtsjukdom och de som avled av icke kardiell orsak var liten. Patienter med aortastenos har påverkad hemodynamik. En ökad afterload ses vilket ger upphov till ökad wall stress och hypertrofi av hjärtmuskeln. VK hypertrofi leder inledningsvis till diastolisk fyllnadsstörning varefter en begynnande myokardfibros sker som slutligen resulterar i nedsatt systolisk funktion. I studie V studerades hur aortastenos påverkar AVPD. AVPD var oberoende korrelerat till graden av aortaklaffens stenosering, medan EF inte påvisade någon korrelation. Våra observationer indikerar att AVPD, men inte EF, påverkas av tidiga hemodynamiska förändringar orsakade av aortastenos. Detta skulle kunna tala för att AVPD är en känsligare mätvariabel än EF och en lämpligare sådan eftersom de flesta patienter med aortastenos har en måttlig grad av stenosering. Sammanfattningsvis, AVPD är ett känsligt mått på VK funktionen eftersom AVPD påverkas redan vid mild ischemi men även vid mindre störningar av diastoliska fyllnaden av VK. Eftersom AVPD påverkas redan vid lätt ökade fyllnadstryck är AVPD också mer känslig för ökat afterload, som vid aorta stenos, än vad EF är. Våra studier tyder också på att AVPD är en bättre prognostisk prediktor än EF att prognosticera död hos patienter med kranskärlssjukdom, hjärtsvikt och förmaksflimmer eftersom AVPD förändras tidigare i sjukdoms förloppet än EF. (Less)
Abstract
Left atrioventricular plane displacement (AVPD) has been shown to correlate well with left ventricular (LV) systolic function measured as ejection fraction (EF). AVPD has also been shown to be related to diastolic performance. Other factors related to AVPD include age, heart rate, LV and atrial dimensions, myocardial thickness, bodysurface, and afterload. In this thesis the left AVPD was studied in relation to some specific clinical conditions. In study I, left AVPD at rest was shown to be related to the degree and extent of CAD, independent of prior myocardial infarction (MI), in 159 patients with coronary angiography verified stable CAD. The AVPD decrease was more pronounced the more widespread the coronary disease. Left AVPD and EF are... (More)
Left atrioventricular plane displacement (AVPD) has been shown to correlate well with left ventricular (LV) systolic function measured as ejection fraction (EF). AVPD has also been shown to be related to diastolic performance. Other factors related to AVPD include age, heart rate, LV and atrial dimensions, myocardial thickness, bodysurface, and afterload. In this thesis the left AVPD was studied in relation to some specific clinical conditions. In study I, left AVPD at rest was shown to be related to the degree and extent of CAD, independent of prior myocardial infarction (MI), in 159 patients with coronary angiography verified stable CAD. The AVPD decrease was more pronounced the more widespread the coronary disease. Left AVPD and EF are different measures of LV function. AVPD reflects systolic and diastolic performance whereas EF only is a measure of LV systolic function. The observation in study II underscores this. AVPD was independently correlated with both LV systolic function and diastolic filling in patients with stable CAD. The more pronounced the diastolic filling impairment, the lower the AVPD. The degree of displacement decrease has a prognostic value in patients with heart failure and in post MI patients. Studies III and IV show that AVPD has a prognostic value regarding mortality in cardiac events in patients with stable CAD and in patients with chronic atrial fibrillation. AVPD correlates independently with mortality in patients with CAD. However, AVPD is related to prognosis in patients with atrial fibrillation but the discriminative value of AVPD decrease is limited since the difference in AVPD between those who died in cardiac events and survivors is rather small. In patients with aortic stenosis, the hemodynamic load with increased afterload causes a rise in LV wall stress. Myocardial hypertrophy develops in response to this. The LV hypertrophy initially leads to diastolic dysfunction. In late stages, reduced LV systolic function can occur as a result of myocardial fibrosis. However, prior to that, increased wall stress can cause LV systolic dysfunction. In study V, in patients with aortic stenosis, AVPD independently correlates to the degree of aortic valve obstruction, whereas LVEF does not. Our results indicate that AVPD may be affected earlier than LVEF by the hemodynamic consequences of aortic stenosis. AVPD may therefore be a more sensitive marker of LV dysfunction in aortic stenosis than LVEF. In summary, this thesis suggests that AVPD is a sensitive marker of LV function. AVPD is already decreased at mild ischemia and is influenced by small changes in diastolic filling impairment. AVPD is also more sensitive than LVEF to increased afterload, as seen in aortic valve obstruction since, AVPD is already affected at slightly increased LV filling pressures. Furthermore, it seems that AVPD is a better predictor of mortality than LVEF, patients with CAD, heart failure and atrial fibrillation in earlier stages of these heart diseases. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Prof Boman, Kurt
organization
publishing date
type
Thesis
publication status
published
subject
keywords
prognosis, aortic stenosis, atrial fibrillation, AVPD, coronary artery disease
pages
110 pages
publisher
Malmö University Hospital, Department of Cardiology, Erik Rydberg, 205 02 Malmö, Sweden,
defense location
Malmö University Hospital
defense date
2003-03-21 10:15
ISBN
91-89625-18-8
language
English
LU publication?
yes
id
737a7005-e218-4de1-a1c4-296ef2750659 (old id 465497)
date added to LUP
2007-09-27 17:34:51
date last changed
2016-09-19 08:45:06
@phdthesis{737a7005-e218-4de1-a1c4-296ef2750659,
  abstract     = {Left atrioventricular plane displacement (AVPD) has been shown to correlate well with left ventricular (LV) systolic function measured as ejection fraction (EF). AVPD has also been shown to be related to diastolic performance. Other factors related to AVPD include age, heart rate, LV and atrial dimensions, myocardial thickness, bodysurface, and afterload. In this thesis the left AVPD was studied in relation to some specific clinical conditions. In study I, left AVPD at rest was shown to be related to the degree and extent of CAD, independent of prior myocardial infarction (MI), in 159 patients with coronary angiography verified stable CAD. The AVPD decrease was more pronounced the more widespread the coronary disease. Left AVPD and EF are different measures of LV function. AVPD reflects systolic and diastolic performance whereas EF only is a measure of LV systolic function. The observation in study II underscores this. AVPD was independently correlated with both LV systolic function and diastolic filling in patients with stable CAD. The more pronounced the diastolic filling impairment, the lower the AVPD. The degree of displacement decrease has a prognostic value in patients with heart failure and in post MI patients. Studies III and IV show that AVPD has a prognostic value regarding mortality in cardiac events in patients with stable CAD and in patients with chronic atrial fibrillation. AVPD correlates independently with mortality in patients with CAD. However, AVPD is related to prognosis in patients with atrial fibrillation but the discriminative value of AVPD decrease is limited since the difference in AVPD between those who died in cardiac events and survivors is rather small. In patients with aortic stenosis, the hemodynamic load with increased afterload causes a rise in LV wall stress. Myocardial hypertrophy develops in response to this. The LV hypertrophy initially leads to diastolic dysfunction. In late stages, reduced LV systolic function can occur as a result of myocardial fibrosis. However, prior to that, increased wall stress can cause LV systolic dysfunction. In study V, in patients with aortic stenosis, AVPD independently correlates to the degree of aortic valve obstruction, whereas LVEF does not. Our results indicate that AVPD may be affected earlier than LVEF by the hemodynamic consequences of aortic stenosis. AVPD may therefore be a more sensitive marker of LV dysfunction in aortic stenosis than LVEF. In summary, this thesis suggests that AVPD is a sensitive marker of LV function. AVPD is already decreased at mild ischemia and is influenced by small changes in diastolic filling impairment. AVPD is also more sensitive than LVEF to increased afterload, as seen in aortic valve obstruction since, AVPD is already affected at slightly increased LV filling pressures. Furthermore, it seems that AVPD is a better predictor of mortality than LVEF, patients with CAD, heart failure and atrial fibrillation in earlier stages of these heart diseases.},
  author       = {Rydberg, Erik},
  isbn         = {91-89625-18-8},
  keyword      = {prognosis,aortic stenosis,atrial fibrillation,AVPD,coronary artery disease},
  language     = {eng},
  pages        = {110},
  publisher    = {Malmö University Hospital, Department of Cardiology, Erik Rydberg, 205 02 Malmö, Sweden,},
  school       = {Lund University},
  title        = {Echocardiographic assessment of atrioventricular plane displacement, Clinical application in patients with coronary artery disease, atrial fibrillation and aortic stenosis},
  year         = {2003},
}