title: CME: long-term outcome in asymptomatic patients with severe aortic regurgitation, normal left ventricular ejection fraction, and severe left ventricular dilatation.
abstract: BACKGROUND
  Although the guidelines consider severe left ventricular (LV) dilatation a class IIaC indication for surgery in asymptomatic patients with severe aortic regurgitation (AR) and normal LV function, the optimal management remains controversial. We aimed to assess the LV enlargement, hypertrophy and function, and the outcomes in these patients by the presence of severe LV dilatation at baseline.
  
  
  METHODS
  From our 20-year database, we identified all asymptomatic patients with severe AR and LV ejection fraction (EF) >50% and ≥2 echocardiograms ≥1 year apart. LV end-diastolic diameter >70 mm or LV end-systolic diameter >50 mm or LV end-systolic diameter index >25 mm/m(2) defined severe LV dilatation. A composite end point included onset of symptoms or LV dysfunction.
  
  
  RESULTS
  Eighty-four patients (52 ± 18 years, 61 men) were enrolled and followed-up for 7.1 ± 5.1 years. Two groups were defined: 22 patients with and 62 patients without severe LV dilatation at baseline. The progression of LV dilatation and hypertrophy, and the LVEF at last exam were similar in both groups. Twelve of 22 and 34 of 62 patients (P = 0.59) reached the end point. Vasodilators did not modify the progression of LV enlargement/hypertrophy. Ten of 22 and 25 of 62 patients (P = 0.45) underwent surgery and had similar postoperative LV diameters, mass, EF.
  
  
  CONCLUSIONS
  The progression of LV enlargement/hypertrophy and outcomes in asymptomatic patients with severe AR, normal LV function, and severe LV dilatation or the postoperative LV parameters were not influenced by the severe LV dilatation, suggesting that a close follow-up could delay surgery in this population.
authors.affiliation: Cardiology ARC, S. Maria degli Angeli Hospital, Via Montereale 24, Pordenone, Italy.
authors.forename: Roxana
authors.initials: R
authors.lastname: Enache
authors.forename: Francesco
authors.initials: F
authors.lastname: Antonini-Canterin
authors.forename: Rita
authors.initials: R
authors.lastname: Piazza
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Popescu
authors.forename: Elisa
authors.initials: E
authors.lastname: Leiballi
authors.forename: Ricarda
authors.initials: R
authors.lastname: Marinigh
authors.forename: Cristina
authors.initials: C
authors.lastname: Andriani
authors.forename: Rosa
authors.initials: R
authors.lastname: Pecoraro
authors.forename: Carmen
authors.initials: C
authors.lastname: Ginghina
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Nicolosi
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality*; D015897:Comorbidity; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000401:mortality*; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D015996:Survival Rate; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality