title: Symptoms, left ventricular function, and timing of valve replacement surgery in patients with aortic regurgitation.
abstract: BACKGROUND
  Because cardiac decompensation is subtle, the best time to perform aortic valve replacement surgery may be difficult to determine. We investigated the relation of symptoms to left ventricular (LV) function and the timing of valve replacement in patients with aortic regurgitation (AR) of largely rheumatic origin.
  
  
  METHODS
  Sixty-eight initially asymptomatic patients (mean age 29 years) with severe chronic AR were monitored for 36 months. Assessments included baseline and yearly echocardiograms and radioisotope ventriculography (resting and exercise) and clinical examinations every 6 months.
  
  
  RESULTS
  Forty-seven patients (69%) remained asymptomatic and 21 (31%) had symptoms develop after 24 to 36 months. Compared with symptomatic patients, asymptomatic patients had significantly (P <.05) lower baseline LV end-diastolic diameter, end-systolic diameter, end-systolic stress, and volume/mass ratio but greater shortening fraction and ejection fraction (EF) at rest. These variables remained stable without statistically significant change until surgical correction in symptomatic patients. Percent variation of EF from rest to exercise increased in patients who remained asymptomatic (EF 2.8% +/- 10.6%) but decreased in those who became symptomatic (EF -4.2% +/- 13%; P <.05). Twenty symptomatic patients (New York Heart Association class III/IV, angina and/or syncope) had valve replacement surgery, after which all were in New York Heart Association class I/II and had significant decreases of LV end-diastolic and end-systolic diameters and an increase on percent variation of EF from rest to exercise (P <.0001).
  
  
  CONCLUSIONS
  Development of symptoms did not correlate with change in any ventricular function indexes. Surgery on appearance of symptoms restored LV function to near normal.
authors.affiliation: Heart Institute, School of Medicine, University of São Paulo, SP, Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Tarasoutchi
authors.forename: M
authors.initials: M
authors.lastname: Grinberg
authors.forename: J P
authors.initials: JP
authors.lastname: Filho
authors.forename: M
authors.initials: M
authors.lastname: Izaki
authors.forename: L F
authors.initials: LF
authors.lastname: Cardoso
authors.forename: P
authors.initials: P
authors.lastname: Pomerantezeff
authors.forename: A
authors.initials: A
authors.lastname: Nuschbacher
authors.forename: P L
authors.initials: PL
authors.lastname: da Luz
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D018579:Patient Selection; D012216:Rheumatic Diseases / Q000150:complications; D016277:Ventricular Function, Left