Aortic valve replacement normalizes left ventricular twist function

The aim of this study was to assess the effect of aortic valve replacement (AVR) on left ventricular (LV) twist function. We studied 28 severe aortic stenosis (AS) patients with normal LV ejection fraction (EF) before and six months after AVR. LV long axis function was assessed using M-mode and tissue Doppler and twist function using speckle tracking echocardiography. The data were compared with 28 age and sex-matched normal controls. In patients, LVEF remained unchanged after AVR. LV long axis function was reduced before surgery but normalized after AVR. LV twist was increased before (19.7 +/- 5.7 degrees vs. 12.9 +/- 3.2 degrees, P<0.001) and normalized after AVR (14.4 +/- 5.2 degrees, P<0.001). In normals, LV twist correlated with LV fractional shortening (r=0.81, P<0.001) but not with EF. This relationship was reversed in patients before (r=0.52, P<0.01) and after AVR (r=0.34, P=ns). In patients with severe AS and normal EF, LV twist is exaggerated suggesting potential compensation for the reduced long axis function. These disturbances normalize within six months of AVR but lose their relationship with basal LV function. (C) 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.