Systolic left atrial failure in elderly women with severe aortic stenosis: mitral and pulmonary vein Doppler analysis by transesophageal echocardiography.
We studied prospectively 35 elder women aged 65-82 years, with isolated severe symptomatic aortic stenosis, referred for aortic valve surgery. We assessed diastolic function by TEE before and after cardiac surgery, although follow-up data were collected in 26 patients. The examination was performed prior to surgery and 6 months after. The control group consisted of 32 patients referred for TEE. In the preoperative study, the velocities and integrals of the waves in the pulmonary vein flow were similar to the people of their same age, except the A-wave of atrial contraction and the integral of the systolic wave, which were significantly smaller (Control A-wave 26.1 +/- 5.1 vs preoperative A-wave 22.6 +/- 5.6, P = 0.009 and control double product A vel xA dur 2,748 +/- 835 vs preoperative 2,273 +/- 968, P = 0.03; systolic integral 14.6 +/- 3.8 vs 11.3 +/- 4, P = 0.0009). Six months after surgery, the PV flow was similar to the control group except for the wave of atrial contraction, which was significantly smaller but tended to normalization (postoperative A-wave 23.3 +/- 5, P = 0.04 vs control, and postoperative double product A vel x A dur 2460 +/- 893, P = 0.21 vs control). Mitral flow parameters did not change in the preoperative and postoperative period. Left ventricular mass index changed from 166 +/- 54 g/m(2) to 105 +/- 39 g/m(2) (P< 0.0001). The results of this study show that in elderly women with symptomatic severe AS, diastolic function does not change, left ventricular mass reduces, with improvement in symptoms, and the left atrium function, considered by pulmonary vein flow, is preoperative depressed and tends to mild recovery in the postoperative period, suggesting systolic LA failure.