Assessment of left ventricular long axis contraction can detect early myocardial dysfunction in asymptomatic patients with severe aortic regurgitation

Abstract

Objective-To identify variables that could be applied at rest to diagnose subclinical ventricular dysfunction in asymptomatic patients with severe aortic regurgitation. Design-Cross sectional study. Patients-Left ventricular long axis contraction was studied using tissue Doppler and M mode echocardiography in 21 patients with no symptoms (New York Heart Association (NYHA) functional class < 2a) but severe aortic regurgitation (jet area/left ventricular outflow tract area > 40%). Main outcome measures-Left ventricular ejection fraction (LVEF) at baseline and peak exercise (Weber protocol), cardiopulmonary function, and left ventricular long axis function at rest (peak systolic velocity and excursion of the mitral annulus). Results-In 11 patients, ejection fraction increased or did not change (from mean (SD) 55 (5)% to 58 (4)%, p < 0.05) (group I); in 10 patients it decreased by > 5% (from 54 (4)% to 42 (5)%, p < 0.001) (group II). Exercise ejection fraction was < 50% in all patients in group II. At rest, there were no diVerences between the groups in ejection fraction, left ventricular diameter indices, wall stress, and short axis contraction. However, patients in group II had reduced long axis contraction compared with group I: peak systolic velocity 8.6 (0.6) v 11.9 (2.2) cm/s (p < 0.001); excursion 11 (2) v 14 (2) mm (p < 0.01). A resting velocity of < 9.5 cm/s was the best indicator of poor exercise tolerance (sensitivity 90%, specificity 100%). Conclusions-Markers of reduced long axis contraction may provide simple and reliable indices of subclinical left ventricular dysfunction in asymptomatic patients with severe aortic regurgitation. (Heart 2001;85:30-36) Keywords: aortic regurgitation; long axis function; tissue Doppler echocardiography; exercise echocardiography Asymptomatic patients with chronic aortic regurgitation have an excellent prognosis if their resting ejection fraction is greater than 45%.1-3 The annual mortality rate is less than 0.5%, but such patients are not a homogeneous group. Thus many remain clinically stable, while 4-6%/year develop left ventricular dysfunction and require surgery.2-4 If operation is deferred in all patients until they become symptomatic, a subset may already have irreversible left ventricular dysfunction. 2-5It is a challenge to recognise patients with subclinical myocardial dysfunction in order to operate early enough to prevent postoperative heart failure, but not so early as to subject them to unnecessary operative risks and morbidity related to prosthetic valves. The reported best predictors of subnormal left ventricular performance in asymptomatic patients with severe aortic regurgitation are a decrease in ejection fraction on exercise (by more than 5%) and a low ejection fraction on exercise (less than 50%) coupled with inappropriately high wall stress, assessed by echocardiography or radionuclide ventriculography.3 5-7 Dynamic stress echocardiography with quantification of left ventricular function is diYcult and time consuming, however, and so it i...

Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed‐Wave Tissue Doppler Imaging

“…The fact that none of the variables was significantly altered in horses with moderate‐to‐severe AR suggests that the clinical use of TDI for the assessment of LV function in horses with AR may be limited. This seems to be in contrast to findings in people, where reduced S m , E m , and A m and prolonged IVCT m , IVRT m , and IMP m provide indices of subclinical LV dysfunction that may serve as prognostic indicators in asymptomatic patients with severe aortic regurgitation 11, 12, 13, 42, 43. However, it should be noted that classification of valvular regurgitation based on receiving chamber analysis of the regurgitant jet may not entirely reflect the hemodynamic status in individual horses.…”

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The subclinical effect of celiac disease on the heart and the effect of gluten-free diet on cardiac functions

“…It has been widely accepted that tissue Doppler echocardiography (TDE) is useful in analyzing subclinical ventricular functions in some cases such as valve regurgitation, anthracycline cardio toxicity, earlier phases of cardiomyopathies and heart transplant rejection [5][6][7][8] . However, the number of studies on TDE's role in analyzing cardiac functions, and the spectrum and frequency of cardiac involvement in children with CD is limited 9,10 .…”

Abnormal Tissue Doppler Images are Associated With Elevated Plasma Brain Natriuretic Peptide and Increased Oxidative Stress in Acute Kawasaki Disease

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