Progression of myocardial dysfunction in asymptomatic patients with severe aortic insufficiency

By serial echocardiographic examinations, we investigated the parameters predictive of left ventricular (LV) deterioration in 38 asymptomatic patients with severe aortic insufficiency (AI). Based on their first echocardiograms, patients were divided into two groups: Group 1 (n = 30) had normal fractional shortening (FS); Group 2 (n = 8) had abnormal FS. Similar values of LV end-diastolic, end-systolic dimension (EDD, ESD), FS, radius/thickness ratio, and mean wall stress characterized stable and unstable patients of Group 1; unstable patients, who developed abnormal values of FS during the follow-up, showed significantly lower values of the contractility index (peak arterial pressure/end-systolic volume ratio, PAP/ESV). The unstable patients, moreover, were distributed near the onset of the downslope and moved along the descending limb of the curvilinear pump performance-myocardial contractility relation. No changes occurred in Group 2 patients during follow-up. Three unstable Group 1 patients and the 8 patients of Group 2 underwent aortic valve replacement (AVR): postoperative EDD was less than 65 mm and the changes from before to after AVR were greater than 11 mm in all cases. We conclude that the pump performance-myocardial contractility relation visualized the unstability of LV function in asymptomatic patients and that AVR can be delayed after the appearance of an abnormal FS for at least 36 months.