Echocardiographic analysis of left ventricular filling in isolated pure chronic aortic regurgitation

Left ventricular (LV) diastolic filling was assessed using digitized M-mode echocardiography in 12 patients with aortic regurgitation (AR) and in 12 normal subjects. Ten patients with AR were asymptomatic and 2 patients had congestive heart failure. LV chamber dimensions, fractional shortening and the rate of change of LV dimensions during systole and diastole were determined. In addition, the timing of the rate of change of LV dimensions in diastole (peak dD/dt, 50% peak dD/dt and 20% peak dD/dt) was also measured. Patients with AR had a significant reduction in dD/dt (12.2 +/- 3.5 cm/s in patients with AR vs 15.9 +/- 1.9 cm/s in normal subjects, p less than 0.01) and a delay in the timing of peak dD/dt (160 +/- 35.2 ms in patients with AR vs 86 +/- 17.6 ms in normal subjects, p less than 0.01) from the minimum LV dimension. These diastolic abnormalities were present in patients with symptomatic as well as those with asymptomatic AR, occurred even when the fractional shortening and peak systolic emptying rate (peak -dD/dt) were normal, and showed no correlation with the calculated LV mass (r = 0.14). The delay in the diastolic filling velocities (peak dD/dt, 50% and 20% peak dD/dt) was associated with a decreased rate of change of LV dimension in diastole, suggesting delayed early LV filling. These findings indicate an abnormality of LV diastolic filling in patients with symptomatic as well as asymptomatic AR and suggest that diastolic abnormalities may precede echocardiographic indexes of systolic LV dysfunction.