RESUMEN
BACKGROUND: Valve replacement for aortic stenosis (AS) determines negative ventricular remodelling. We used cross sectional and Doppler echocardiography to check how rapidly it occurs and to assess if these changes are sustained over time. METHODS: We evaluated in 34 patients subjected to aortic valve replacement for AS morphological and functional (ejection fraction and E:A ratio) left ventricular data by echocardiography prior to surgery and 2 postoperative studies: early after surgery (pQ1) and at mid-term evolution (pQ2). RESULTS: Left ventricular mass index was reduced at pQ1 (from 152 +/- 47 g/m2 to 113 +/- 31 g/m2; p < 0.01) as well as end-diastolic (from 51.3 mm to 48.3 mm; p < 0.03), end-systolic (from 32.2 mm to 29.4 mm; p < 0.02), interventricular septum (from 12.9 mm to 10.3 mm; p < 0.01), and posterior wall (from 12.5 mm to 11 mm; p < 0.01) dimensions. Left ventricular ejection fraction (from 61.2% to 65.2%; p < 0.04) and E:A ratio (from 0.94 to 0.98; p < 0.01) increased significantly at pQ1. There were no significant differences in measurements between pQ1 and pQ2. CONCLUSIONS: Aortic valve replacement surgery leads to a rapid negative left ventricular remodelling during the first 7 months, including a decrease in myocardial hypertrophy and an improvement in systolic and diastolic function. These beneficial hemodynamic changes are sustained for at least 3 years.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Ventrículos Cardíacos/fisiopatología , Hipertrofia Ventricular Izquierda/etiología , Remodelación Ventricular , Anciano , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Ecocardiografía Doppler , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/fisiopatología , Hipertrofia Ventricular Izquierda/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Volumen Sistólico , Factores de Tiempo , Resultado del TratamientoRESUMEN
Long-term studies on left ventricular (LV) adaptation have not been reported. The echocardiograms of 41 top-class runners (8 males and 6 females sprint-trained, 15 males and 12 females endurance-trained) were recorded at the beginning and after 1, 2, and 3 years of training. A one-way ANOVA and a linear regression analysis were conducted to determine changes and association between performance and LV values. Training resulted in an increase in performance and LV internal diameter at end-diastole (LVIDd) and decreases in end-diastolic interventricular septal wall thickness, and posterior wall thickness (PWTd). There were no significant differences in LV mass and LV ejection fraction (LVEF, %). The changes in PWTd were linked to enlargement of the LV. In athletes with unusual LV dilatation (>60 mm), LVIDd was related to performance and LVEF was >50%. Maximal wall thickness was <13 mm in all athletes. LV adaptations were independent of sex and type of training and related to the initial level of performance. We believe that LV enlargement in elite runners is a physiological adaptation and that the LVIDd is a predictor of running performance.
Asunto(s)
Adaptación Fisiológica , Ventrículos Cardíacos/anatomía & histología , Resistencia Física , Aptitud Física , Carrera , Función Ventricular , Adulto , Cardiomegalia , Ecocardiografía , Ejercicio Físico , Femenino , Humanos , Estudios Longitudinales , Masculino , MiocardioRESUMEN
We evaluated the echocardiograms of 134 male and 54 female elite runners who competed over different distances to observe cardiac enlargement and differences among athletes engaged in different types of training, and to relate the echographic dimension with running performance. In male runners, left ventricular (LV) internal diameter at end diastole (LVIDd), LV mass, and left atrial diameter were increased by the length of distance ( P < .001) whereas right ventricular diameter was increased only in marathon runners. In female runners, this association was found when LVIDd, LV mass, and left atrial diameter were adjusted for body surface area ( P < .001). Wall thickness was not related to distance running. Abnormal LV dilation was associated with a low LV ejection fraction for the higher values of LVIDd, but not for the higher indexed LVIDd values. In male runners, LVIDd was associated with 100 m ( r = -0.67, P < .01), 10,000 m ( r = -0.70, P < .001), and marathon ( r = -0.54, P < .001) and in female runners with a 400-m ( r = -0.84, P < .001) race time. These results show that sprint- and endurance-trained runners had an eccentric hypertrophy and that it is necessary to establish a new upper limit of abnormal cavity dilatation as indexed LVIDd. The normal systolic function and the relationship between LVIDd and performance indicate that LV enlargement in elite runners is a physiologic adaptation and that echocardiographic assessment can be used to determine the fitness of runners.