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[Echocardiography in chronic aortic insufficiency. Prediction of the reversibility of left ventricular dysfunction
Insights
Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) can restore left ventricular (LV) function. Preoperative echocardiogram indices predict normalisation of LV function post-AVR, guiding patient selection.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Context:
- Chronic aortic regurgitation (AR) can lead to left ventricular (LV) dysfunction.
- The long-term outcome after aortic valve replacement (AVR) depends on LV function recovery.
- Assessing preoperative LV status is crucial for predicting post-AVR outcomes.
Purpose:
- To identify predictors of complete left ventricular (LV) dysfunction regression after aortic valve replacement (AVR).
- To analyze echocardiographic parameters before and after AVR in patients with chronic AR.
- To stratify patients based on the likelihood of LV functional normalization post-AVR.
Summary:
- 49 patients with chronic AR undergoing AVR were divided into two groups based on postoperative LV dimensions and function.
- Group I showed normal LV dimensions and wall motion, while Group II had persistent dilation/hypokinesis.
- Key echocardiographic indices (e.g., % delta Dd, EF, %FS) predict a ~90% probability of LV function normalization if below certain thresholds post-AVR.
Impact:
- Establishes specific echocardiographic criteria to predict LV function recovery after AVR for chronic AR.
- Provides valuable information for surgical decision-making and patient counseling regarding AVR outcomes.
- Highlights the significance of preoperative left ventricular assessment in managing chronic aortic regurgitation.
Unlabelled:
The long term outcome of patients undergoing aortic valve replacement (AVR) for chronic aortic regurgitation (AR) is mainly determined by the reversibility or permanence of left ventricular dysfunction. We analysed the echocardiogram of 49 patients before and after surgery to identify the patients whose left ventricular dysfunction regressed completely after AVR. The patients were divided into 2 groups according to the results of the last postoperative echocardiogram: Group I: 25 patients whose left ventricular dimensions and wall motion reverted to normal; Group II: 24 patients with dilated and/or hypokinetic left ventricles. The two groups of patients were comparable for sex (Group I: 19 men, 6 women; Group II: 20 men, 4 women), age (Group I: 50,8 years, Group II: 53,9 years) and length of postoperative follow-up (Group I: 32 months, Group II: 34 months). The following parameters were measured and compared: diastolic and systolic left ventricular dimensions, myocardial mass and ventricular wall motion.
Results:
Patients in Group I had less left ventricular dilatation than those in Group II (+35% vs +60%, p less than 0,001) and left ventricular contraction was better (FE: 62% vs 45%, p less than 0,001; %FS: 35% vs 23%, p less than 0,001). This study establishes that patients with chronic AR and % delta Dd less than 60%, an EF greater than 50% or %FS greater than 25%, have about a 90% probability of normalisation of LV function after AVR. If one of the indices exceeds these threshold values, the probability of permanent LV dilatation and/or hypokinesia after AVR is also about 90%.(ABSTRACT TRUNCATED AT 250 WORDS)