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[Median-term course of left ventricular effects in aortic insufficiency. Echocardiographic study of 90 patients]
Insights
In chronic aortic regurgitation (AR), significant left ventricular (LV) dilatation (delta DD > 30%) leads to progressive deterioration of LV dimensions, mass, and systolic function (EF, %FS) over time.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Physiology
Context:
- Chronic pure aortic regurgitation (AR) causes progressive left ventricular (LV) remodeling.
- Understanding the natural evolution of LV changes is crucial for identifying critical thresholds for functional decline.
Purpose:
- To analyze the longitudinal changes in LV dimensions, mass, and contractility in patients with chronic AR.
- To determine echocardiographic parameters indicative of LV functional deterioration.
Summary:
- This echocardiographic study followed 90 patients with chronic AR for an average of 34.6 months.
- Patients were grouped by the degree of ventricular dilatation (delta DD < 30% vs. > 30%).
- Significant increases in LV dimensions and mass, and decreases in ejection fraction (EF) and fractional shortening (%FS), were observed annually in the group with greater dilatation (delta DD > 30%).
Impact:
- Identifies a delta DD > 30% as a critical threshold associated with declining LV systolic function in chronic AR.
- Provides insights into the natural history of LV remodeling and dysfunction in AR.
- Highlights the importance of serial echocardiographic monitoring to detect functional deterioration.
Abstract:
It is important to know the natural evolution of the changes in left ventricular dimensions and contractility in AR if one wishes to determine the critical echocardiographic values at which LV function starts to deteriorate. This was the aim of our echocardiographic study of 90 patients with chronic pure AR in whom we analysed the changes in LV dimensions, mass and contractility for 11 to 84 months (average 34.6 months). The patients were divided into 2 groups according to the degree of ventricular dilatation (delta DD): Group A: delta DD less than 30% (58 patients), Group B: delta DD greater than 30% (32 patients). The annual mean increase in diastolic and systolic LV dimensions and myocardial mass in each group was: 1.5 mm vs 3.2 mm (p less than 0.02); 0.9 mm vs 4.1 mm (p less than 0.003), 14 g vs 24 g (p = 0.07 NS) respectively. The parameters of the systolic function were normal in Group A (EF = 68 +/- 8% and % FS = 38 +/- 6%) and decreased in Group B (EF = 58 +/- 13%, % FS = 32 +/- 9%). A significant annual decrease of the mean values of these parameters was only observed in patients of Group B (EF = 1.8% per year; % FS = -1.2% per year). These results are on average of unequal individual variations: variations of DD or EF greater than the variability due to the reproducibility of the method were only observed in 43 patients. The number of patients in whom echocardiographic changes were observed was comparable in Groups A and B.(ABSTRACT TRUNCATED AT 250 WORDS)