Prognostic value of preoperative indexed end-systolic left ventricle diameter in the outcome after surgery in patients with chronic aortic regurgitation.
BACKGROUND
End-systolic diameter (ESD) is an important parameter in the prognosis and indication for surgery in chronic aortic regurgitation (AR). It has been suggested that ESD values noncorrected for body surface area (BSA) could be inappropriate in the management of patients with extreme BSA. The aim of the study was to assess the usefulness of indexed ESD (IESD) of the left ventricle in the management of patients with severe isolated chronic AR.


METHODS
One hundred forty-seven patients underwent surgery for chronic AR and were followed up for a mean of 8 +/- 6 years (1-22 years). A post hoc assessment was made of the prognostic value of preoperative ESD and IESD in different BSA percentiles: group 1, <or= 25th percentile (BSA 1.43-1.68 m(2), n = 40); group 2, >25th percentile and <or=75th percentile (BSA 1.69-1.91 m(2), n = 68); and group 3, >75th percentile (BSA 1.92-2.24 m(2), n = 39).


RESULTS
Age-adjusted preoperative ESD and IESD were independent predictors of mortality or heart failure in the entire population. Magnitude of the relative risk was slightly greater using preoperative IESD than ESD (HR 1.07, 95% CI 1.01-1.29, P = .017; HR 1.04, 95% CI 1.01-1.08, P = .016). In group 1, the age-adjusted expected mortality rate would drop if IESD of 25 mm/m(2) was used as a surgical criterion instead of ESD 50 mm, from 37.94% to 24.27% at 10 years (P = .002).


CONCLUSIONS
The use of IESD improves the prediction of unfavorable outcomes after surgery in patients with low BSA but not in those with high BSA. In patients with low BSA, IESD >or=25 mm/m(2) should be used as a cutoff point for surgery rather than ESD >50 mm.
Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. asambola@vhebron.net
Antonia
A
Sambola
Pilar
P
Tornos
Ignacio
I
Ferreira-Gonzalez
Artur
A
Evangelista
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000473:pathology* / Q000601:surgery*; D001830:Body Surface Area; D006348:Cardiac Surgical Procedures; D002908:Chronic Disease; D004108:Dilatation, Pathologic; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D013599:Systole; D016896:Treatment Outcome