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[Quantitative echocardiographic study of the left ventricular function in acute aortic infective endocarditis]
R Scognamiglio1, P Della Valentina, P Melacini
1Cattedra di Cardiologia, Università di Padova.
Giornale Italiano Di Cardiologia
|June 1, 1988
Summary
Infective endocarditis patients with severely depressed myocardial contractility and inadequate hypertrophy face high surgical risk. Adequate hypertrophy is crucial for reversing left ventricular dysfunction after aortic valve replacement.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Surgery
Background:
- Infective endocarditis (IE) can lead to significant left ventricular (LV) dysfunction.
- Identifying patients at high surgical risk is crucial for optimizing outcomes in IE management.
Purpose of the Study:
- To identify high surgical risk patients with native aortic valve IE.
- To characterize irreversible myocardial damage patterns.
- To correlate LV function with operative mortality and post-operative recovery.
Main Methods:
- M-mode and 2D-echocardiography were used to assess LV function in 45 IE patients.
- Key parameters included LV volumes, ejection fraction (EF), peak systolic pressure to end-systolic volume ratio (PAP/ESV), LV mean systolic wall stress, and radius to thickness ratio (R/Th).
Main Results:
- Operative mortality was 15% in 13 patients undergoing aortic valve replacement, primarily due to heart failure.
- Severely depressed myocardial contractility (PAP/ESV < 2) and inadequate hypertrophy (R/Th > 4) identified patients with surgical mortality.
- Reversal of LV dysfunction post-surgery depended on hypertrophy; normal EF was achieved only with adequate hypertrophy (R/Th < 4).
Conclusions:
- Echocardiographic parameters, specifically PAP/ESV and R/Th, can identify high-risk patients with IE.
- Myocardial contractility and the pattern of LV hypertrophy are critical determinants of surgical outcomes and post-operative recovery.