Asymptomatic severe aortic regurgitation in the young. Hemodynamic and angiographic data in 37 patients with...

The aim of this study was to evaluate from hemodynamic and angiocardiographic (ACG) data the extent of left ventricular (LV) systolic dysfunction in a group of predominantly young (mean age 29 years) asymptomatic patients with severe aortic regurgitation (AR). In addition, echocardiography was performed and these data were correlated with ACG data and the value of these parameters in predicting LV dysfunction was tested. Thirty-seven patients were catheterized and 18 demonstrated LV dysfunction with an ejection fraction (EF) of less than 50%. These patients were classified as group A and the remaining 19 patients with EF greater or equal to 50% formed group B. While there was no difference between the 2 groups with regard to age or regurgitant fraction, the end-diastolic pressure was raised (p less than 0.01) and cardiac index depressed (p less than 0.05) significantly in group A. Of the echocardiographic parameters, the end-systolic diameter (ESD) correlated best with the EF (coefficient of correlation = -0.7 and p less than 0.001). In addition, the ESD was significantly higher in group A (p less than 0.001). When an ESD greater than or equal to 48 mm was used as a predictor of an EF less than 50% (group A) the sensitivity was 89% and the specificity 79%. In conclusion, many young asymptomatic patients with severe AR may have severe LV systolic dysfunction and an ESD greater than or equal to 48 mm is a good predictor of such a subgroup.