Observations on the optimum time for operative intervention for aortic regurgitation. II. Serial echocardiographic evaluation of asymptomatic patients.
Why the study?
Do echocardiographic indices of left ventricular systolic function predict the development of symptoms requiring operation in asymptomatic patients with aortic regurgitation?
Population
37 asymptomatic patients with aortic regurgitation
Design
Cohort
Follow-up
mean 34 months
Authors
Discussion
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Implication
May aid risk stratification by LV dimensions in asymptomatic AR; leaves open whether thresholds should guide operative timing.
Key Points
- To determine whether serial echocardiographic measurements of left ventricular systolic function identify asymptomatic patients with aortic regurgitation who require operative intervention.
- Prospective longitudinal evaluation of 37 asymptomatic patients with isolated aortic regurgitation followed by serial echocardiography over a mean follow-up of 34 months.
- Serial echocardiographic measurements, including left ventricular end-systolic dimension (LVD[SYS]) and percent fractional shortening (%FS), were analyzed to distinguish patients who developed symptoms requiring surgery from those who remained asymptomatic.
- Baseline LVD[SYS] (53.0 mm in the surgical group vs. 44.3 mm in the non-operative group, p = 0.001) and %FS (28.8% vs. 33.9%, p = 0.002) were the most sensitive parameters distinguishing patients who subsequently required operation (n = 14, 38%) from those remaining asymptomatic (n = 23, 62%).
- During follow-up, 80% (4 of 5) of patients with an initial LVD[SYS] > 55 mm developed symptoms and underwent surgery (mean follow-up 39 months), compared to only 20% (4 of 20) of patients with an initial LVD[SYS] ≤ 50 mm, among whom no deaths occurred.
Structured PICO
Do echocardiographic indices of left ventricular systolic function predict the development of symptoms requiring operation in asymptomatic patients with aortic regurgitation?
P
Population
37 asymptomatic patients with aortic regurgitation
I
Intervention
Serial echocardiographic evaluation
O
Outcome
Development of symptoms requiring operative interventionhard clinical
In asymptomatic patients with aortic regurgitation, an end-systolic dimension ≥55 mm identifies a high risk for developing symptoms requiring operation, whereas <50 mm indicates low risk.
Cite This Study
Henry et al. (1980) studied this question.