title: Impact of associated significant aortic regurgitation on left ventricular remodeling and hemodynamic impairment in severe aortic valve stenosis.
abstract: OBJECTIVE
  The left ventricular (LV) response to combined pressure and volume overload [aortic stenosis (AS) and aortic regurgitation (AR)] versus pressure overload (isolated AS)has not been systematically studied. We aimed to assess LV remodeling, functional and hemodynamic consequences inpatients with mixed aortic valve disease versus patients with isolated AS.
  
  
  METHODS
  We enrolled 181 patients (67 ± 9 years,109 men) with severe AS (aortic valve area indexed to body surface area <0.6 cm 2 /m 2 ) who underwent preoperative cardiac catheterization and a complete echocardiogram. Pulmonary capillary wedge pressure (PCWP), LV end-diastolic pressure (LVEDP) and pulmonary artery pressure (PAP) were measured.
  
  
  RESULTS
  One hundred and ten patients (group A)had isolated severe AS (AR 0–1) and 71 patients (group B)had mixed aortic valve disease (severe AS plus AR 2–3). Patients in group B were younger and in a higher New York Heart Association class (p < 0.01). Severity of AS was similar in both groups. Patients in group B had a higher indexed LV mass, a lower LV ejection fraction, and higher PCWP, LVED Pand PAP (all p ≤ 0.01).
  
  
  CONCLUSIONS
  Patients with severe AS and significant AR are more symptomatic than patients with isolated severe AS. The increased burden due to the combined lesion induces pronounced LV remodeling and more severe hemodynamic consequences.
authors.affiliation: Carol Davila University of Medicine and Pharmacy, RO–022328 Bucharest, Romania.
authors.forename: Andreea Catarina
authors.initials: AC
authors.lastname: Popescu
authors.forename: Francesco
authors.initials: F
authors.lastname: Antonini-Canterin
authors.forename: Roxana
authors.initials: R
authors.lastname: Enache
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Nicolosi
authors.forename: Rita
authors.initials: R
authors.lastname: Piazza
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.forename: Matteo
authors.initials: M
authors.lastname: Cassin
authors.forename: Doina
authors.initials: D
authors.lastname: Dimulescu
authors.forename: Carmen
authors.initials: C
authors.lastname: Ginghină
authors.forename: Bogdan Alexandru
authors.initials: BA
authors.lastname: Popescu
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000503:physiopathology; D006328:Cardiac Catheterization; D002302:Cardiac Output / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology*