Author + information
- Received March 27, 1994
- Revision received July 8, 1994
- Accepted July 11, 1994
- Published online December 1, 1994.
- Mark J. Pirwitz, MD,
- Richard A. Lange, MD, FACC,
- John E. Willard, MD, FACC,
- Charles Landau, MD, FACC,
- D.Brent Glamann, MD and
- L.David Hillis, MD, FACC∗
- ↵∗Address for correspondence: Dr. L. David Hillis, Room CS 7.102, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9047.
Objectives. This study was designed to assess the left ventricular peak systolic pressure/end-systolic volume (PSP/ESV) ratio in predicting symptomatic improvement with valve replacement in patients with aortic regurgitation and enlarged left ventricular volume.
Background. Patients with aortic regurgitation and a left ventricular end-systolic volume ≤ 60 ml/m2show symptomatic improvement with valve replacement, whereas the response of those with an enlarged end-systolic volume > 60 ml/m2is mixed. Most benefit, but some do not. Valve replacement appears to help those whose end-systolic volume is enlarged because of excessive left ventricular afterload but appears to have little or no effect in those whose end-systolic volume is enlarged because of depressed left ventricular contractility.
Methods. We studied 27 patients (21 men and 6 women aged 18 to 72 years) with moderate or severe aortic regurgitation, no other cardiovascular abnormalities and left ventricular end-systolic volume > 60 ml/m2. In this group we assessed the ability of preoperative variables routinely measured at cardiac catheterization to predict symptomatic improvement with valve replacement
Results. Of the 27 subjects, 1 (4%) died 51 days postoperatively. Six months postoperatively, symptoms had lessened in 17 patients (63%), were unchanged in 8 (29%) and had worsened in 1 (4%). By multivariate analysis, the PSP/ESV ratio was the strongest predictor of both functional class 6 months postoperatively (p = 0.026) and change in functional class from before operation to 6 months postoperatively (p = 0.033). By 6 months after valve replacement, all patients with a ratio ≥ 1.72 mm Hg/ml per m2were in functional class I or II; in contrast, of those with a ratio < 1.72 mm Hg/ml per m2, 31% were in functional class III, and 1 (8%) had died.
Conclusions. The PSP/ESV ratio may help to predict which patients with aortic regurgitation and enlarged left ventricular end-systolic volume will have symptomatic improvement with valve replacement.
- Received March 27, 1994.
- Revision received July 8, 1994.
- Accepted July 11, 1994.