Circulation, Vol 71, 669-680, Copyright © 1985 by American Heart Association
WG Daniel, WP Hood Jr, A Siart, D Hausmann, U Nellessen, H Oelert and PR Lichtlen
The prognostic significance of a preoperative echocardiographic left
ventricular end-systolic dimension (ESD) greater than 55 mm and/or
fractional shortening (FS) of 25% or less was evaluated retrospectively in
84 patients who had undergone aortic valve replacement for isolated chronic
aortic regurgitation due to various causes. Postoperative survival,
improvement in symptoms, and echocardiographic evidence of regression of
left ventricular dilatation and hypertrophy were compared between patients
with a preoperative ESD greater than 55 mm (category 1) and those with an
ESD of 55 mm or less (category 2) and between patients with FS of 25% or
less (category 3) and those with FS greater than 25% (category 4). Patients
in categories 1 and 3 had a higher preoperative left ventricular
end-diastolic dimension (EDD) and cross- sectional area than those in
categories 2 and 4, respectively, but their preoperative functional
impairment (NYHA class) was similar. There were 13 deaths, only two of
which (one early, one late) could be attributed to left ventricular
dysfunction. In both, FS was 25% or less and in one ESD was greater than 55
mm. There was a weak association without useful positive predictive value
between the echocardiographic variables and postoperative death due to all
causes. Among 42 patients with a preoperative ESD greater than 55 mm and/or
FS of 25% or less, 33 (79%) were alive at a mean follow-up of 29.5 months.
Symptoms improved in all categories of survivors, with the postoperative
NYHA class being similar between categories 1 and 2 and between categories
3 and 4. Among 48 survivors with high-quality echocardiograms both before
and after surgery, EDD fell in all groups but fell to a lesser extent in
category 3 than in category 4. Postoperative cross-sectional area fell to
the same level in all categories. Follow-up intervals were similar in all
categories. We conclude that in patients undergoing aortic valve
replacement for chronic aortic regurgitation, a preoperative ESD greater
than 55 mm or an FS of 25% or less does not reliably predict early or late
death, does not correlate with lack of improvement in symptoms, and does
not preclude postoperative regression of left ventricular dilatation and
hypertrophy. Thus these echocardiographic criteria alone cannot be used for
the timing of surgical intervention in these patients.
ARTICLES
Chronic aortic regurgitation: reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening
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