Radionuclide angiographic exercise left ventricular performance in chronic aortic regurgitation: Relationship to resting echographic ventricular dimensions and systolic wall stress index

Lewis, Stanley M.; Riba, Arthur; Berger, Harvey J.; Davies, Ross A.; Wackers, Frans J. Th.; Alexander, Jonathan; Sands, Milton J.; Cohen, Lawrence S.; Zaret, Barry L.

doi:10.1016/0002-8703(82)90336-2

Cited by 44 publications

(10 citation statements)

References 30 publications

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“…Some studies have suggested that an exerciseinduced decrease in LVEF is a predictor of poor outcome that warrants surgery. 22,[55][56][57] However, most of these studies included patients who already had symptoms, LV dilation, or decreased resting LVEF. Thus, it is not clear that exercise LVEF is helpful in determining the need for surgery in asymptomatic patients with normal LV size and function.…”

Section: Role Of Exercise Testingmentioning

confidence: 99%

Valvular Heart Disease

2005

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Abstract-Aortic regurgitation (AR) is characterized by diastolic reflux of blood from the aorta into the left ventricle (LV).Acute AR typically causes severe pulmonary edema and hypotension and is a surgical emergency. Chronic severe AR causes combined LV volume and pressure overload. It is accompanied by systolic hypertension and wide pulse pressure, which account for peripheral physical findings, such as bounding pulses. The afterload excess caused by systolic hypertension leads to progressive LV dilation and systolic dysfunction. The most important diagnostic test for AR is echocardiography. It provides the ability to determine the cause of AR and to assess the severity of AR and its effect on LV size, function, and hemodynamics. Many patients with chronic severe AR may remain clinically compensated for years with normal LV function and no symptoms. These patients do not require surgery but can be followed carefully for the onset of symptoms or LV dilation/dysfunction. Surgery should be considered before the LV ejection fraction falls below 55% or the LV end-diastolic dimension reaches 55 mm. Symptomatic patients should undergo surgery unless there are excessive comorbidities or other contraindications. The primary role of medical therapy with vasodilators is to delay the need for surgery in asymptomatic patients with normal LV function or to treat patients in whom surgery is not an option. The goal of vasodilator therapy is to achieve a significant decrease in systolic arterial pressure. Future therapies may focus on molecular mechanisms to prevent adverse LV remodeling and fibrosis. Key Words: aorta Ⅲ echocardiography Ⅲ valves Ⅲ ventricles A ortic regurgitation (AR) is characterized by diastolic reflux of blood from the aorta into the left ventricle (LV) due to malcoaptation of the aortic cusps. Its clinical presentation is variable and depends on a complex interplay of a number of factors, including acuity of onset, aortic and LV compliance, hemodynamic conditions, and severity of the lesion. Although chronic AR is generally well tolerated for many years, acute AR may lead to rapid cardiac decompensation and, if untreated, to early death. 1 This review focuses on the clinical manifestations of AR, evaluation of its severity and hemodynamic consequences, and its treatment. PrevalenceThe prevalence of chronic AR and incidence of acute AR are not precisely known. Singh et al 2 reported the prevalence of chronic AR detected by color Doppler echocardiography in a large unselected adult population (the Framingham Offspring Study). The overall prevalence AR in men was 13% and in women 8.5%. However, most of the AR in this population was trace or mild in severity; moderate or severe AR was rare (Table 1). Multiple logistic regression analysis revealed age and male gender to be predictors of AR. Interestingly, hypertension did not predict AR on multivariate analysis, confirming results of earlier studies that hypertension is associated with modest increases in aortic root size but not AR when age is included in the...

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Section: Role Of Exercise Testingmentioning

confidence: 99%

Valvular Heart Disease

2005

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“…The ejection fraction response to exercise has not proved to have independent prognostic value in patients undergoing surgery. 254 The change in ejection fraction with exercise is a relatively nonspecific response related to both severity of volume load 271,296,300,301 and exercise-induced changes in preload and peripheral resistance 280 that develop early in the natural history of AR. AVR should also not be recommended in asymptomatic patients with normal systolic function merely because of evidence of LV dilatation as long as the dilatation is not severe (end-diastolic dimension less than 75 mm or endsystolic dimension less than 55 mm).…”

Section: Asymptomaticmentioning

confidence: 99%

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2008

Circulation

911

259

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“…4, 561-569, 1984. IT IS generally agreed that aortic valve replacement for between contractility and loading conditions at rest patients with chronic severe aortic regurgitation should and during exertion can account for this apparent disnot always be delayed until the appearance of severe crepancy.7 8 Nevertheless, myocardial dysfunction, symptoms. [1][2][3][4][5][6] An impairment of myocardial contractilwhether or not it is associated with severe symptoms, ity can be present even in the absence of significant can be irreversible, preventing improvement or adsymptoms in these patients.…”

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confidence: 99%

Echocardiographic evaluation of the response to afterload stress test in young asymptomatic patients with chronic severe aortic regurgitation: sensitivity of the left ventricular end-systolic pressure-volume relationship.

Branzi¹,

Lolli²,

Piovaccari³

et al. 1984

Circulation

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The detection of myocardial depression is an important goal in the management of patients with chronic severe aortic regurgitation but may be quite difficult at an early stage by the conventional basal measures of contractility. The response to afterload stress determined by angiotensin challenge and the end-systolic pressure-volume relationship was evaluated echocardiographically in 16 asymptomatic or mildly symptomatic patients with chronic severe aortic regurgitation, ages 15 to 56 years (mean 32 ± 12). Nine normal subjects, ages 25 to 41 years (mean 31 ± 5), served as a control group. In the group with aortic regurgitation, end-systolic dimensions were greater than 55 mm in five of 16 patients and fractional shortening was 25% or less in two of 16. In the control group angiotensin caused a decrease of stroke volume index in six out of nine patients (15% at the most) and a mild increase in three. In the group with aortic regurgitation stroke volume index decreased by 15% or more of the basal value in nine of 16 patients and increased or decreased by less than 15% in seven of 16. Ejection fraction decreased in both groups, from 61 ± 6% to 52 ± 7% in the control group and from 56 ± 6% to 45 ± 5% in the group with aortic regurgitation. Ventricular

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Radionuclide angiographic exercise left ventricular performance in chronic aortic regurgitation: Relationship to resting echographic ventricular dimensions and systolic wall stress index

Cited by 44 publications

References 30 publications

Valvular Heart Disease

Valvular Heart Disease

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Echocardiographic evaluation of the response to afterload stress test in young asymptomatic patients with chronic severe aortic regurgitation: sensitivity of the left ventricular end-systolic pressure-volume relationship.

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