Circulation, Vol 82, 798-807, Copyright © 1990 by American Heart Association
K Taniguchi, S Nakano, Y Kawashima, K Sakai, T Kawamoto, S Sakaki, J Kobayashi, S Morimoto and H Matsuda
Left ventricular ejection performance, wall stress, and contractile state
were evaluated in 35 patients with chronic aortic regurgitation.
Cineangiography and pressure measurements were obtained before and a mean
of 26 months after aortic valve replacement, and data were compared with
those from 30 normal control subjects. The relation between quantitative
changes in wall stress and changes in ejection fraction after surgery was
determined. Preoperatively, end-systolic stress was elevated in patients
with aortic regurgitation (218 +/- 45 vs. 160 +/- 23 kdynes/cm2 [mean +/-
SD] for control subjects, p less than 0.01), and ejection fraction was
depressed (0.46 +/- 0.11 vs. 0.65 +/- 0.05, p less than 0.01). End-systolic
stress decreased postoperatively (151 +/- 41 kdynes/cm2, p less than 0.01)
and ejection fraction increased (0.58 +/- 0.11, p less than 0.01). The
magnitude of increase in ejection fraction correlated significantly and
negatively (r = -0.65) with the quantitative change in end-systolic stress
after surgery. Contractile function, as assessed by the ejection phase
index- end-systolic stress relation, did not significantly change: 23 of 35
patients preoperatively and 18 of 35 patients postoperatively had values
that clearly fell below the 95% confidence limit of the ejection
fraction-end-systolic stress relation for controls. After surgery,
individual ejection fraction-end-systolic stress relationships demonstrated
a shift parallel to the regression curve for the control subjects.
Moreover, persistent postoperative left ventricular hypertrophy was
significantly associated with persistent contractile dysfunction. Thus,
late improvement in left ventricular ejection performance after aortic
valve replacement can be attributed to the reduction in end-systolic
stress. Contractile function itself was not improved by surgery. Persistent
postoperative hypertrophy may be a marker for myocardial contractile
dysfunction.
ARTICLES
Left ventricular ejection performance, wall stress, and contractile state in aortic regurgitation before and after aortic valve replacement
First Department of Surgery, Osaka University Medical School, Japan.
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