Serial noninvasive assessment of left ventricular hypertrophy and function after surgical correction of aortic regurgitation

Schuler, Gerhard; Peterson, Kirk L.; Johnson, Allen D.; Francis, Gary S.; Ashburn, William L.; Dennish, George W.; Daily, Pat O.; Ross, John

doi:10.1016/0002-9149(79)90273-x

Cited by 113 publications

(46 citation statements)

References 30 publications

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“…LV weight was assessed by both LV mass 10 and meridional crosssectional area (CSA). 11 Relative diastolic wall thickness, defined as 2 x posterior wall thickness (PWT)/ LVIDd, was calculated as an index of concentric thickening of cardiac walls. End-systolic stress was calculated using the equation of Wilson et al 12 ; echocardiogram and cuff blood pressure obtained with a random-zero sphygmomanometer (Hawksley, Lancing, UK) were assessed simultaneously as an index of afterload seen in the myocardium.…”

Section: Methodsmentioning

confidence: 99%

Supernormal contractility in primary hypertension without left ventricular hypertrophy.

et al. 1988

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SUMMARY Forty-three subjects with uncomplicated primary hypertension and without echocardtographic left ventricular hypertrophy and 54 normotensive volunteers were studied by two-dimensional targeted M-mode echocardiography to evaluate systolic function and contractility before the development of compensatory hypertrophy. The ratio of peak systolic pressure to end-systolic dimension was used to assess left ventricular performance and was divided for either posterior wall thickness or cross-sectional area to generate hypertrophy-independent indices of inotropic state. Fractional shortening was normal in the hypertensive group, despite the increase in end-systolic stress. Systolic pressure/dimension ratio was higher in hypertensive subjects (p< 0.001), as were hypertrophy-independent indices of inotropic state (p< 0.005), which were inversely correlated to left ventricular mass (p<0.001). Values in 11 hypertensive subjects were above the upper confidence limit of the normal shortening/stress relation, which provides a load-independent measure of inotropic state. They showed high hypertrophy-independent indices of inotropic state (p<0.01), while the other hypertensive subjects did not. High fractional shortening, wall stress, and systolic pressure (p<0.01) were found in the subgroup with supernormal performance, while left ventricular mass was not different from that of other subgroups, depicting inadequate left ventricular hypertrophy. The duration of hypertension was the same in the subgroups. Supernormal inotropic state could be considered one form of primary adaptation to high wall stress that serves to maintain systolic ventricular performance. (Hypertension 11: 457-463, 1988) KEY WORDS • contractility • arterial hypertension • systolic function T HE role of left ventricular (LV) contractility in the maintenance of pump function during hypertensive disease is still under investigation. Some evidence suggests that performance is enhanced in subjects with primary hypertension, 1 " 3 but its mechanism of action is unclear. An increase in cardiac performance can be due to either improved inotropic state or an increase in the amount of myocardium available for contraction. Although enhancement of contractile force has been thought to be associated with increased LV mass,

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Section: Methodsmentioning

confidence: 99%

Supernormal contractility in primary hypertension without left ventricular hypertrophy.

et al. 1988

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“…The patients were operated on between February 1975 and January 1983; 48 patients received bioprostheses (37 Hancock. three Xenomedica, six Carpentier-Edwards, and two Vascor-pericard) and 36 received mechanical devices (19 Bjork-Shiley, 10 Lillehei-Kaster, and seven St. Jude Medical). Myocardial preservation was by cold potassium cardioplegia.…”

Section: Methodsmentioning

confidence: 99%

Chronic aortic regurgitation: reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening.

Daniel¹,

Hood²,

Siart³

et al. 1985

Circulation

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The prognostic significance of a preoperative echocardiographic left ventricular endsystolic 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. Circulation 71, No. 4, 669-680, 1985

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“…The contribution of long-axis shortening to EF is only 3-7% (equation 2), and thus explains the excellent correlation observed in this study between %ID2 and radionuclide EF despite the frequent occurrence of apical dyssynergy. Also in support of this concept is the well-established accuracy of M-mode echocardiography in deriving EF from the fractional shortening of the LV dimension in the absence of regional dyssynergy.7, [19][20][21] Third, small errors or differences in absolute measurements of the LV dimensions at end-diastole and end-systole may cancel each other and result in only minor differences in fractional shortening. Analysis of the measurements made by the two independent observers supports this concept; although some discrepancy (and, thus, lower correlation) was seen between the two observers' measurement of enddiastolic and end-systolic dimensions, an excellent correlation was found between the measurement of %AD2 and EF by the two observers.…”

Section: Echocardiographic Measurement Of Efmentioning

confidence: 99%

A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography.

Quiñones

Waggoner²,

Reduto³

et al. 1981

Circulation

682

268

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SUMMARY A new method to determine left ventricular (LV) ejection fraction (EF) with wide-angle, twodimensional echocardiography (2-D echo) has been developed using the parasternal long-axis, apical fourchamber and apical long-axis views. End-diastolic and end-systolic measurements of LV short axes at the base and mid-LV cavity in the parasternal long-axis view and at the upper, middle and lower thirds of the cavity in the apical views are made, from which an averaged minor axis at end-diastole and at end-systole is calculated. Wide-angle 2-D echoes were obtained in each patient using a commercially available mechanical sector scan (Advanced Technology Laboratories Mark V). The scan head consists of three rotating 3-MHz piezoelectric crystals that are sequentially pulsed as they pass through a 900 sector. The frame rate of the system varies from 45.5 frames/sec at a scan depth of 5 cm to 18.5 frames/sec at a depth of 21 cm. The images are converted to digital format by a digital scan converter and presented in video format to the observer, allowing greater resolution and an enhanced gray scale. All studies were video-taped on a ¾h-inch Umatic video-cassette recorder (Panasonic VD-2600) interfaced to a back spacer search module (Dynasciences EJ-104 model 1), which allows frameby-frame bidirectional playback. The video frame rate of the system is approximately 60 frames/sec.All patients were studied in the left lateral recum-

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Serial noninvasive assessment of left ventricular hypertrophy and function after surgical correction of aortic regurgitation

Cited by 113 publications

References 30 publications

Supernormal contractility in primary hypertension without left ventricular hypertrophy.

Supernormal contractility in primary hypertension without left ventricular hypertrophy.

Chronic aortic regurgitation: reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening.

A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography.

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