Left ventricular diastolic filling in valvular aortic stenosis

The pattern of left ventricular diastolic filling in patients with valvular aortic stenosis (AS) as assessed by gated blood pool scintigraphy has received little attention. Twenty-one normal persons (group 1), 24 patients with significant AS and ejection fractions of 50% or more (group 2) and 15 patients with significant AS and ejection fractions less than 50% (group 3) were studied. From the time-activity curve, the peak filling rate and mean filling rate (as end-diastolic volumes [EDV]/s) and percent stroke volume filled at first third of diastole and at the end of the rapid filling period were determined. Group 2 had a reduced peak filling rate (2.58 ± 0.65 EDV/ s, p < 0.05) compared with group 1 (3.11 ± 0.65 EDV/s). Similarly, the percent stroke volume filled at the end of the rapid filling period was reduced in group 2. Group 3 patients had a lower peak filling rate and mean filling rate than group 1 patients. However, percent stroke volume filled at first third of diastole and percent stroke volume filled at the end of the rapid filling period were greater in group 3 than in group 1. Two distinct patterns of diastolic filling were noted in patients with AS. Group 2 patients had reduced peak filling rates with less diastolic filling during the rapid filling period. Although the peak filling rate was reduced in group 3, more complete filling occurred during the rapid filling period.