Diastolic function predicts outcome after aortic valve replacement in patients with chronic severe aortic regurgitation.
BACKGROUND
Due to eccentric hypertrophy and fibrosis, patients with severe aortic regurgitation (AR) have diastolic dysfunction. Increased fibrosis correlates with increased myocardial stiffness and worsening of diastolic function. Patients with irreversible left ventricular (LV) dysfunction have severe myocardial fibrosis and myocyte apoptosis and do not benefit from aortic valve replacement (AVR).


OBJECTIVE
To investigate whether diastolic properties of LV predicts outcome after AVR in patients with chronic severe AR and LV systolic dysfunction.


METHODS
The study population consisted of 41 patients with chronic severe AR and LV systolic dysfunction. Preoperative echocardiographic examinations were repeated at the postoperative 6th month. Left ventricular ejection fraction (LVEF) was calculated. Diastolic function was evaluated with Doppler echocardiography. Patients were classified as Group 1 (impaired relaxation), Group 2 (pseudonormalization), and Group 3 (restrictive pattern).


RESULTS
Postoperative LVEF was significantly increased in Group 1, whereas it tended to decrease in Group 3. Left ventricular size was significantly decreased in Group 1 and 2 during the postoperative period. Multivariate linear regression analysis showed that deceleration time and early/late ratio were independent predictors of postoperative changes in LVEF.


CONCLUSIONS
Assessment of diastolic function is a reliable parameter in predicting outcome of AVR in patients with chronic AR and systolic dysfunction.
Cayli
Murat
M
Department of Cardiology, Cukurova University, Faculty of Medicine, Adana, Turkey. drcayli@yahoo.com
Kanadaşi
Mehmet
M
Akpinar
Onur
O
Usal
Ayhan
A
Poyrazoğlu
Hakan
H
D000328:Adult; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology