Abstract 3369: Prognostic Value of Indexed Systolic Left Ventricle Diameter in Chronic Severe Aortic Regurgitation
Background: Left ventricular (LV) diameters have been recommended in chronic severe aortic regurgitation (AR) to assess surgical indication. It has been suggested that indexed value of end-systolic LV (corrected by body surface) (IESD) may optimize the value of end-systolic diameter (ESD) to establish surgical indication in AR.
Objective: We assessed the prognostic value of IESD in patients with chronic severe asymptomatic AR.
Results: One hundred eighty-six patients (148 m, 38 f; age 46±14 y) with pure chronic severe AR were followed-up between 1982 to 2005. Follow-up was 7±5 y (1–22 y). Surgery was indicated whenever symptoms appeared or when EF<50% and/or ESD>50 mm were found. During this period 132 pts (71%) underwent surgery. Fifty-five patients (42%) remained with a 1-year postoperative depressed EF (<50%). IESD>25mm/m2 predicted 1-y postoperative depressed EF in a higher number of pts than ESD>50 mm (48 pts (87%) vs 39 pts (71%), p=0.0001). Overall mortality was 37 pts (19.8%) through follow-up. Among pts who died IESD>25mm/m2 was present in 33 pts (89%) vs ESD>50 mm in 25 pts (68%), p=0.007. The presence of a combined variable IESD>25 mm/m2 and/or EF<50% was present in 35 pts (95%) of those who died while an ESD>50 mm and or EF <50% was present in 30 pts (83%), p=0.024. In a Cox analysis model with preoperative variables, symptoms and EF<50% were independent predictors of death or heart failure, while ESD, EDD as well as indexed ESD, EDD were not. In another Cox analysis with a 1-y postoperative variables, an IESD>25 mm/m2 was an independent predictor to late mortality adjusted by age (HR 10.05; 95% CI: 1.87 to 54.13, p=0.007).
Conclusions: IESD>25mm/m2 is useful to establish optimal surgical criteria for chronic aortic regurgitation. Late mortality in patients operated on for chronic aortic regurgitation can be predicted by a 1-year postoperative IESD>25mm/m2.