Aortoseptal angulation and left ventricular hypertrophy pattern: an echocardiographic study in patients with aortic valvular stenosis.

ABSTRACT

We studied 15 patients with valvular aortic stenosis (mean age 63 +/- 14 [SD] years) with M-mode, two-dimensional, and Doppler echocardiography to evaluate the influence of aortoseptal angulation on left ventricular changes. The diastolic aortoseptal angle averaged 118 degrees +/- 4 degrees in 10 patients (group I) and 96 degrees +/- 17 degrees in five patients (group II) (p less than 0.05). Left ventricular outflow tract diameter was significantly narrower in group II versus group I (1.5 +/- 0.5 cm versus 2.1 +/- 0.2 cm, p less than 0.01), and severe left ventricular outflow tract obstruction developed in two patients in group II after surgery. Moreover, diastolic aortoseptal angulation did not correlate with any of left ventricular indexes in group I but correlated significantly with left ventricular diastolic posterior wall thickness in group II (r = -0.975, p = 0.025). We conclude that aortoseptal angulation in aortic stenosis may alter left ventricular geometry, and its clinical significance may be related to its effects on postoperative accentuation of left ventricular outflow tract obstruction.