Background: The presence of an abnormal late-peaking left ventricular velocity contour, detected by Doppler echocardiography, has been reported in patients with hypertrophic cardiomyopathy, left ventricular hypertrophy, and aortic stenosis.
Methods and results: To evaluate the clinical and prognostic significance of this characteristic Doppler finding, we studied a group of patients (n = 57) with isolated AS undergoing aortic valve replacement. Patients were divided into two groups according to the presence (n = 28) or absence (n = 29) of a hypertrophic late-peaking left ventricular velocity pattern. There were no differences between the groups with respect to age, sex, and presence of coronary artery disease. Peak preoperative aortic valve gradients were similar in both groups (70 vs. 67 mm Hg; p = not significant). The postoperative course of patients with abnormal late-peaking ventricular velocity contour was complicated by a higher incidence of arrhythmias (80% vs. 38%; p = 0.0002). Hypotension and the use of inotropic support were significantly more common in the group with abnormal late-peaking ventricular velocity contour (79% vs. 24%; p = 0.0001 and 76% vs. 26%; p = 0.0001, respectively). Hemodynamically, patients with a late-peaking velocity pattern exhibited a higher pulmonary diastolic pressure (16+/-3 vs 12+/-2 mm Hg; p = 0.0003), wedge pressure (12+/-4 vs 10+/-2; p < 0.05), and systemic vascular resistance (2126+/-459 vs 1553+/-199; p = 0.0001) and lower cardiac index (2.4+/-0.3 vs 2.9+/-0.4; p = 0.0001).
Conclusions: An abnormal late-peaking ventricular velocity contour pattern appears to be a high risk marker for postoperative complications in patients undergoing aortic valve replacement. Routine Doppler evaluation in patients undergoing valve replacement for AS may therefore identify these patients.