Revista argentina de cardiología
versión On-line ISSN 1850-3748
FALCONI, Mariano L. et al. Serial Evaluation of Asymptomatic Patients with Severe Aortic Regurgitation and Normal Left Ventricular Systolic Function: Study Based on Left Ventricular Dimensions and Valve Lesion. Rev. argent. cardiol. [online]. 2006, vol.74, n.5, pp. 281-288. ISSN 1850-3748.
Background Asymptomatic patients with severe aortic regurgitation (AR) and normal left ventricular function can develop symptoms and ventricular dysfunction. An assessment of the type of valve lesion combined with indices of ventricular size and their progression during follow up has not been performed to date. Objective To identify changes in ventricular size indices and valve lesion to predict symptoms, need for valve replacement, ventricular dysfunction and cardiac death. Material and Methods A total of 254 asymptomatic patients with severe AR (mean age 63±7 years; 74% male; ejection fraction [EF[ 64±5%) were included. End points were development of symptoms, ventricular dysfunction (EF<55%), valve replacement or cardiac death. Results During a mean follow up of 4.7±2.3 years, 72 patients developed symptoms and 97 left ventricular dysfunction while 61 patients required aortic valve replacement. All cause mortality was 11/254 (4.3%). Univariate analysis identified age, end diastolic (EDDBS) and systolic diameters (ESDBS) adjusted by body surface, effective regurgitant orifice area (EROA), left atrial diameter and exercise EF as associated to the end point. However, Cox analysis identified the rate of change of ESDBS and EROA, and initial left ventricular size (EDDBS and ESDBS) as independent predictors. Conclusion In asymptomatic patients with severe AR, the rate of change of ventricular size and valve lesion were independent predictors of the development of symptoms, ventricular dysfunction and valve replacement, thus allowing for a better risk stratification.
Palabras clave : Aortic valve insufficiency; Echocardiography; Heart valve prosthesis.