Ventricular long-axis contraction as an earlier predictor of outcome in asymptomatic aortic regurgitation.
The long-term prognostic significance of left ventricular (LV) long-axis contraction was investigated prospectively in 65 consecutive patients aged 58+/-15 years with asymptomatic aortic regurgitation, normal LV ejection fraction at rest, and no coronary artery or aortic root disease. A complete transthoracic echocardiographic study was performed at baseline and 12 months later. In 24 of 65 patients with peak systolic wave velocity at the lateral mitral annulus (LatS)<9 cm/s, LV diameter (p<0.01), volume (p<or=0.01), mass (p<0.001), and end-systolic wall stress (p<0.001) significantly increased after 12 months, whereas LV shortening and ejection fraction (p=0.001) and tissue Doppler right ventricular peak systolic wave velocity (p<0.05) decreased significantly. In patients with peak systolic wave velocity at the lateral mitral annulus>or=9 cm/s, none of these parameters was significantly affected during follow-up. Aortic valve replacement was performed in 6 of 24 patients (25%) with peak systolic wave velocity at the lateral mitral annulus<9 cm/s and none with peak systolic wave velocity at the lateral mitral annulus>or=9 cm/s. In patients with peak systolic wave velocity at the lateral mitral annulus<9 cm/s, a cut-off value of 6.25 cm/s predicted aortic valve replacement within the next year with 97% sensitivity and 83% specificity. In conclusion, ventricular long-axis contraction seems to be a reliable indicator for outcome prediction in patients with asymptomatic aortic regurgitation.
Second Department of Cardiology, Athens University Medical School, Attiko University Hospital, Athens, Greece.
Ioannis A
IA
Paraskevaidis
Stamatis
S
Kyrzopoulos
Dimitrios
D
Farmakis
John
J
Parissis
Dimitrios
D
Tsiapras
Efstathios K
EK
Iliodromitis
Dimitrios Th
DT
Kremastinos
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology