Effects of Aortic Valve Replacement on Left Ventricular Dyssynchrony in Aortic Stenosis with Narrow QRS Complex

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The presence and determinants of left ventricular (LV) dyssynchrony in patients with aortic stenosis (AS) are not clear. The aims of this study were to (1) investigate the presence and determinants of LV dyssynchrony and (2) assess if LV dyssynchrony could improve after aortic valve replacement (AVR) in patients with AS with narrow QRS complexes.


Twenty healthy subjects and 30 consecutive patients with AS were retrospectively studied. AVR was performed in 19 patients. The time to peak systolic velocity with reference to the QRS complex (Ts), the standard deviation of Ts (Ts-SD), and maximal difference of Ts were measured as the index of LV dyssynchrony in 12 LV segments on Doppler tissue imaging.


Ts-SD (25 ± 17 vs 52 ± 15 msec) and the maximal difference of Ts (70 ± 47 vs 148 ± 38 msec) were significantly greater (P < .001) in patients with AS than in healthy subjects. Early after AVR (11 ± 4 days), LV dyssynchrony significantly improved with the shortening of Ts-SD (29 ± 14 msec) and the maximal difference of Ts (91 ± 42 msec) (P < .001). Ts-SD was significantly correlated with estimated LV systolic pressure (r = 0.53, P < .001) and LV mass index (r = 0.28, P = .02).


LV dyssynchrony is not uncommon in patients with AS with narrow QRS complexes and is reversible early after AVR, suggesting the favorable effect of afterload reduction on dyssynchronous LV contraction.

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