Dobutamine-Stress Echocardiography as a Predictor of Cardiac Function after Surgery for Aortic Valve Regurgitation with Poor Function

Abstract

Background: Patients with aortic valve regurgitation (AR) present at a late stage with impaired function. Some may not show improved function after surgery. Aim of the work:To evaluate the functional outcome in patients with and without poor left ventricular (LV) function and to evaluate the role of dobutamine echocardiography in predicting persistent dysfunction after surgery. Patients and Methods: Patients with severe AR (71) who underwent valve replacement (AVR) were divided into 2 groups based on the ejection fraction (EF); Group I: patients with EF <50% and Group II: patients with EF >50%. Group I was subdivided into 2 subgroups according to the response to dobutamine-stress echocardiography (DSE): Group Ia: patients whose EF increased to >50%, and Group Ib: patients whose EF remained <50%. Six months postoperatively, echocardiography was performed to assess the cardiac function and volumes. Results: Seventy one patients were included in the study: 39(54.9%) in Group I, 32(45.1%) in Group II, 21(29.6%) in Group Ia and 18(25.4%) in Group Ib. Preoperative criteria was not significantly different between the 2 groups apart from the intensive care unit (ICU) stay which was longer in group I (p = 0.006). In group Ia, EF raised on DSE (p < 0.001) and after surgery (p < 0.001). In group II, EF showed significant change on DSE (p < 0.001), but not after surgery (p = 0.203). Conclusions: Preoperative DSE can predict improvement of LV function after AVR in cases with severe AR with ventricular dysfunction.