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

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 ≤ 1.0 cm²) 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 (Δ) 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 ΔAVG (r = −0.84, P = 0.0001), with ΔPEP/LVET (r = −0.87, P = 0.0001), and with ΔAoDP (r = −0.89, P = 0.0001), but not with ΔLVEDP (r = 0.23, P = 0.31). On multivariate analysis, only age was associated with ΔAVG (r² = 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. Cathet Cardiovasc Intervent 2002;55:23–27. © 2002 Wiley-Liss, Inc.