Key result
A preoperative regurgitant stroke volume to end-diastolic volume ratio >0.28 was associated with a lower rate of persistent left ventricular enlargement after valve replacement (17% vs 50%).
Why the study?
Does the preoperative RSV/EDV ratio predict the regression of left ventricular dimensions after valve replacement in patients with severe aortic insufficiency?
Cohort (n=34)
Does the preoperative RSV/EDV ratio predict the regression of left ventricular dimensions after valve replacement in patients with severe aortic insufficiency?
Absolute Event Rate: 17% vs 50%
The preoperative RSV/EDV ratio is a potentially useful predictor for the normalization of left ventricular dimensions, aiding in the assessment of proper timing for valve replacement in severe aortic insufficiency.
May support RSV/EDV-guided timing of AVR in aortic insufficiency; leaves open need for prospective validation before practice change.
The aim of this study was to assess the value of regurgitant stroke volume (RSV) to end-diastolic volume (EDV) ratio to predict the regression of left ventricular (LV) dimensions after uncomplicated valve replacement in 34 patients with severe pure aortic insufficiency. The RSV/EDV ratio was measured by contrast ventriculography and thermodilution techniques. LV end-diastolic diameter (EDD) was measured pre- and postoperatively by M-mode echocardiography (at a median interval of 3.3 years after valve replacement). LV/EDD decreased from 74 +/- 8 mm to 54 +/- 11 mm (P less than 0.001). Eleven patients had a persistent postoperative LV enlargement (median EDD 65 mm, range 56-100 mm) while, in 23 patients, EDD became normal (median 49 mm, range 40-55 mm). During follow-up, one patient with LV enlargement died of congestive heart failure. Preoperative RSV/EDV ratio was significantly higher in patients with normal postoperative EDD as compared to those with persistent LV enlargement (0.32 +/- 0.06 vs. 0.24 +/- 0.07, P less than 0.005). The best cutoff point of RSV/EDV to predict the normalization of LV dimensions was 0.28. Postoperative EDD remained abnormal in eight out of 16 patients (50%) with RSV/EDV ratio less than 0.29, while it remained enlarged in only three out of 18 patients (17%) with a preoperative RV/EDV ratio greater than 0.28. The other usual preoperative catheterization and echocardiographic variables were equally or less predictive than RSV/EDV ratio. In conclusion, despite the limitations due to the use of different techniques, we confirmed that the RSV/EDV ratio is a potentially useful variable for the assessment of the proper timing of valve replacement in patients with severe isolated aortic insufficiency.
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Roelandt et al. (1987) conducted a cohort in Severe pure aortic insufficiency (n=34). Preoperative regurgitant stroke volume to end-diastolic volume (RSV/EDV) ratio > 0.28 vs. RSV/EDV ratio < 0.29 was evaluated on Persistent postoperative left ventricular enlargement. A preoperative regurgitant stroke volume to end-diastolic volume ratio >0.28 was associated with a lower rate of persistent left ventricular enlargement after valve replacement (17% vs 50%).
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