Author + information
- Received August 17, 1982
- Revision received April 18, 1983
- Accepted April 29, 1983
- Published online March 1, 1984.
- Arnold K. Gash, MD, FACCa,
- Blase A. Carabello, MD, FACC,
- Robert L. Kent, PhD,
- John A. Frazier, MD and
- James F. Spann, MD, FACC
- ↵aAddress for reprints: Arnold K. Gash, MD, Section of Cardiology, Temple University Hospital, 3401 N. Broad Street, Philadelphia, Pennsylvania 19140.
Isolated mitral stenosis and isolated aortic insufficiency impose unique and opposite loading conditions on the left ventricle. To assess these combined effects, hemodynamic and angiographic factors were compared among normal subjects and patients with isolated mitral stenosis, isolated aortic insufficiency or combined mitral stenosis and aortic insufficiency. Left ventricular end-diastolic volume index was lower in patients with combined lesions and severe or moderate aortic insufficiency than in patients with isolated severe or moderate aortic insufficiency (138 ± 19 versus 206 ± 20 cc/m2and 87 ± 5 versus 145 ± 22 cc/m2, respectively) (p < 0.05 for both). Left ventricular end-diastolic and end-systolic volume indexes were normal in two-thirds of patients with combined lesions and moderate or severe aortic insufficiency, whereas these indexes were high in all but one patient with isolated moderate or severe aortic insufficiency.
Among patients with moderate or severe aortic insufficiency, 8 of 14 with isolated insufficiency had a reduced ejection fraction or circumferential fiber shortening rate compared with 5 of the 9 patients with combined lesions. Among patients with isolated aortic insufficiency, left ventricular end-systolic wall stress and end-diastolic and end-systolic volume indexes were higher (p < 0.05) in those with reduced ejection performance than in those with normal ejection performance. These variables did not differ between patients with reduced or normal ejection performance in the group with combined lesions.
The contractile index (ratio of end-systolic wall stress to end-systolic volume index) was significantly depressed in patients with severe aortic insufficiency in the groups with isolated aortic insufficiency or combined lesions. Among patients with moderate or severe aortic insufficiency, 7 of 14 of those with an isolated lesion and 5 of 9 with combined lesions had a lower than normal linear end-systolic wall stress/fractional shortening relation.
It is concluded that: 1) mitral stenosis reduces the left ventricular volume overload of aortic insufficiency when these lesions coexist; 2) elevated left ventricular wall stress, excessive left ventricular dilation and reduced shortening characterize patients with aortic insufficiency and low ejection performance, but not patients with combined mitral stenosis and aortic insufficiency and low ejection performance, despite significant aortic insufficiency; and 3) the status of left ventricular systolic muscle function in patients with combined lesions is not entirely clear, but may involve a functional spectrum between isolated mitral stenosis and isolated aortic insufficiency.
- Received August 17, 1982.
- Revision received April 18, 1983.
- Accepted April 29, 1983.
- American College of Cardiology Foundation