Relation between myocardial contractility, hypertrophy and pump performance in patients with chronic aortic regurgitation: an echocardiographic study

Scognamiglio, R; Roelandt, Jos R.T.C.; Fasoli, G; Marchese, Domenico; Prandi, A.; Stritoni, P

doi:10.1016/0167-5273(84)90327-9

Cited by 8 publications

(7 citation statements)

References 31 publications

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“…No patient exhibited a pump performance-myocardial contractility relation similar to that found in congestive cardiomyopathy patients (Scognamiglio et al, 1984).…”

Section: Resultsmentioning

confidence: 75%

“…Thus, PAP/ESV is highly predictive of left ventricular deterioration in patients with chronic AI. The pump performance-myocardial contractility relation, previously described (Scognamiglio et al, 1984), visualized the unstability of left ventricular function: patients with stable left ventricular function were distributed on the plateau of the curvilinear relation; those with an unstable pattern of left ventricular function, instead, were distributed near the onset of the downslope and moved along the descending limb during the follow-up (Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

“…In severe aortic insufficiency (AI), aortic valve replacement (AVR) abolishes chronic left ventricular volume overload, thus reducing systolic wall stress; in spite of this unloading mechanism (Copeland et al, 1977;Greves et al, 1981;Henry et al, 1980a) some symptomatic patients with preoperative left ventricular systolic dysfunction develop early congestive heart failure following surgery. Quantitative echocardiography is able to identify these risk patients: an indequate hypertrophy (Gaasch et al, 1978) and a pump performance-myocardial contractility relation similar to that found in patients with idiopathic dilated cardiomyopathy (Scognamiglio et al, 1984) characterize those with a poor prognosis. The utilization of the left ventricular end-systolic dimension as a marker for timing AVR can lead to conflicting results (Fioretti ef al., , Henry et al, 1980a.…”

Section: Introductionmentioning

confidence: 97%

“…Quantitative echocardiography is able to identify these risk patients: an indequate hypertrophy (Gaasch et al, 1978) and a pump performance-myocardial contractility relation similar to that found in patients with idiopathic dilated cardiomyopathy (Scognamiglio et al, 1984) characterize those with a poor prognosis. The utilization of the left ventricular end-systolic dimension as a marker for timing AVR can lead to conflicting results (Fioretti ef al., , Henry et al, 1980a.…”

Section: Introductionmentioning

confidence: 99%

“…However, a prophylactic AVR was indicated in asymptomatic patients with normal systolic function, to preserve irreversible myocardial damage (Isom et al, 1974;Kirklin et al 1973;Smith et al, 1976). Bonow et al (1983) demonstrated that asymptomatic subjects with normal fractional shortening values (FS) have an excellent prognosis without surgery and that the onset of symptoms or of left ventricular dysfunction (FS < 29%) does not preclude successful…”

Section: Introductionmentioning

confidence: 99%

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Progression of myocardial dysfunction in asymptomatic patients with severe aortic insufficiency

Scognamiglio

Fasoli

Volta

1986

Clinical Cardiology

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Summary: By serial echocardiographic examinations, we investigated the parameters predictive of left ventricular (LV) deterioration in 38 asymptomatic patients with severe aortic insufficiency (AI). Based on their first echocardiograms, patients were divided into two groups: Group 1 (n=30) had normal fractional shortening (FS); Group 2 (n=8) had abnormal FS. Similar values of LV end-diastolic, end-systolic dimension (EDD, ESD), FS, radiuslthickness ratio, and mean wall stress characterized stable and unstable patients of Group I ; unstable patients, who developed abnormal values of FS during the followup, showed significantly lower values of the contractility index (peak arterial pressure/end-systolic volume ratio, PAP/ESV). The unstable patients, moreover, were distributed near the onset of the downslope and moved along the descending limb of the curvilinear pump performance-myocardial contractility relation. No changes occurred in Group 2 patients during follow-up. Three unstable Group 1 patients and the 8 patients of Group 2 underwent aortic valve replacement (AVR): postoperative EDD was less than 65 mm and the changes from before to after AVR were greater than 1 1 mm in all cases. We conclude that the pump performance-myocardial contractility relation visualized the unstability of LV function in asymp tomatic patients and that AVR can be delayed after the appearance of an abnormal FS for at least 36 months.

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“…No patient exhibited a pump performance-myocardial contractility relation similar to that found in congestive cardiomyopathy patients (Scognamiglio et al, 1984).…”

Section: Resultsmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Progression of myocardial dysfunction in asymptomatic patients with severe aortic insufficiency

Scognamiglio

Fasoli

Volta

1986

Clinical Cardiology

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Effects of unloading and positive inotropic interventions on left ventricular function in asymptomatic patients with chronic severe aortic insufficiency

Scognamiglio

Fasoli

Visintin

et al. 1987

Clinical Cardiology

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Summary:The effect of an unloading (nifedipine, 20 mg sublingually) and of a combined unloading and positive inotropic intervention (nifedipine plus digoxin, 0.5 mg intravenously) on left ventricular performance was assessed in 48 patients with chronic severe aortic insufficiency. The left ventricular pump function-myocardial contractility relation (ejection fraction, EF vs. peak arterial pressure to end-systolic volume ratio, PAP/ESV), and the pump function-afterload relation (EF vs. mean systolic wall stress, MWS) were constructed by means of quantitative M-mode and two-dimensional echocardiography . In patients with normal control pump function (n= 14), nifedipine markedly decreased MWS, moving the patients to a new, more advantageous EF-MWS relation. In the 34 patients with abnormal pump function, the myocardial contractility level was the mean factor conditioning the response to pharmacological intervention. Patients with a value of PAP/ESV greater than 2.5 (n=22) had normalization of EF after nifedipine and were upgraded to a mote advantageous outlook for left ventricular mechanics EF-MWS and EF-PAP/ESV relations. Of the 12 patients without normalization of EF after nifedipine, only the 4 patients with PAP/ESV greater than 2 had normalization of pump function indices after combined administration of nifedipine and digoxin.

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End-Systolic Stress Volume Relationships in Chronic Aortic Regurgitation

Carabello¹,

Spann²

1988

Developments in Cardiovascular Medicine

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Relation between myocardial contractility, hypertrophy and pump performance in patients with chronic aortic regurgitation: an echocardiographic study

Cited by 8 publications

References 31 publications

Progression of myocardial dysfunction in asymptomatic patients with severe aortic insufficiency

Progression of myocardial dysfunction in asymptomatic patients with severe aortic insufficiency

Effects of unloading and positive inotropic interventions on left ventricular function in asymptomatic patients with chronic severe aortic insufficiency

End-Systolic Stress Volume Relationships in Chronic Aortic Regurgitation

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