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European Journal of Echocardiography Advance Access published online on June 9, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep079
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Dynamic left ventricular dyssynchrony: a potential cause of no contractile reserve in patients with low-gradient aortic stenosis

Patrizio Lancellotti1,*, Catherine Szymanski2, Marie Moonen1, Christophe Garweg1, Kim O'Connor1, Christophe Tribouilloy2 and Luc A. Piérard1

1 Department of Cardiology, University Hospital of Liège, B-4000 Liège, Belgium
2 Department of Cardiology, University Hospital of Amiens, Picardie, France

Received 13 March 2009; accepted after revision 16 May 2009.

* Corresponding author. Tel: +32 4 366 71 94; fax: +32 4 366 71 95. E-mail address: plancellotti{at}chu.ulg.ac.be


  Abstract

Dobutamine stress echocardiography (DSE) has the potential to stratify patients with low-gradient aortic stenosis (AS) but little is known about ventricular dyssynchrony associated with AS. We report the case of a patient who presented AS associated with left ventricular (LV) dyssynchrony. A DSE was performed, which showed no contractile reserve but an increase in LV dyssynchrony. In this patient, the reduced aortic valve area was probably because of the association of inadequate forward stroke volume due to ischaemic cardiomyopathy and fixed severe AS. The cause of LV dysfunction may include a certain degree of intrinsic myocardial dysfunction due to ischaemic cardiomyopathy and afterload mismatch associated with dynamic LV dyssynchrony, which could be a determinant of forward stroke volume response.

Keywords: Aortic stenosis; Low gradient; Left ventricular dyssynchrony


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