Assessment of left ventricular long axis contraction can detect early myocardial dysfunction in asymptomatic patients with severe aortic regurgitation.
OBJECTIVE
To identify variables that could be applied at rest to diagnose subclinical ventricular dysfunction in asymptomatic patients with severe aortic regurgitation.


METHODS
Cross sectional study.


METHODS
Left ventricular long axis contraction was studied using tissue Doppler and M mode echocardiography in 21 patients with no symptoms (New York Heart Association (NYHA) functional class </= 2a) but severe aortic regurgitation (jet area/left ventricular outflow tract area > 40%).


METHODS
Left ventricular ejection fraction (LVEF) at baseline and peak exercise (Weber protocol), cardiopulmonary function, and left ventricular long axis function at rest (peak systolic velocity and excursion of the mitral annulus).


RESULTS
In 11 patients, ejection fraction increased or did not change (from mean (SD) 55 (5)% to 58 (4)%, p < 0.05) (group I); in 10 patients it decreased by > 5% (from 54 (4)% to 42 (5)%, p < 0.001) (group II). Exercise ejection fraction was < 50% in all patients in group II. At rest, there were no differences between the groups in ejection fraction, left ventricular diameter indices, wall stress, and short axis contraction. However, patients in group II had reduced long axis contraction compared with group I: peak systolic velocity 8.6 (0.6) v 11.9 (2.2) cm/s (p < 0.001); excursion 11 (2) v 14 (2) mm (p < 0.01). A resting velocity of < 9.5 cm/s was the best indicator of poor exercise tolerance (sensitivity 90%, specificity 100%).


CONCLUSIONS
Markers of reduced long axis contraction may provide simple and reliable indices of subclinical left ventricular dysfunction in asymptomatic patients with severe aortic regurgitation.
Vinereanu
D
D
Cardiovascular Sciences Research Group, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK.
Ionescu
A A
AA
Fraser
A G
AG
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications*; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology; D003430:Cross-Sectional Studies; D003971:Diastole; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D010101:Oxygen Consumption; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology