Age-related decline in postextrasystolic potentiation in patients with aortic stenosis

Abstract

In aortic stenosis (AS), postextrasystolic potentiation (PESP), a measure of contractile reserve, has been demonstrated by an increased aortic valve gradient (AVG) after a ventricular extrasystole (VE). We studied age-related changes in PESP in 20 consecutive patients (age, 65-89 years) with significant AS (aortic area <or= 1.0 cm(2)) on cardiac catheterization with VE on AVG pressure recording. Hemodynamics and LV systolic time intervals were averaged from three consecutive beats and from the post-VE beat. Changes (Delta) in AVG, pre-ejection period/LV ejection time ratio (PEP/LVET), aortic diastolic pressures (AoDP), and LV end-diastolic pressures (LVEDP) were calculated. Age was inversely correlated with DeltaAVG (r = -0.84, P = 0.0001), with DeltaPEP/LVET (r = -0.87, P = 0.0001), and with DeltaAoDP (r = -0.89, P = 0.0001), but not with DeltaLVEDP (r = 0.23, P = 0.31). On multivariate analysis, only age was associated with DeltaAVG (r(2) = 0.72, P = 0.0001). There was an age-related decline in PESP in patients with AS, which was accompanied by changes in contractile reserve and afterload reduction, but independent of preload reserve.