Raimonda Verseckaitė, Jūratė Petrauskaitė, Jūratė Drazdauskaitė, Jolanta Laukaitienė, Vaida Mizarienė, Renaldas Jurkevičius
Background. Chronic severe aortic regurgitation (AR) imposes significant volume and pressure overload on the left ventricle (LV), in compensatory but eventually detrimental structure changes in the myocardium. The development of LV systolic dysfunction precedes symptoms onset in more than one-fourth of patients with this condition. The LV ejection fraction (EF) has limitations in predicting early LV dysfunction. Therefore, more sensitive parameters of LV function evaluation are needed. The purpose of this study was to identify variables to diagnose subclinical LV long axis contraction dysfunction in asymptomatic patients with chronic AR with preserved LVEF and their predictive value in the development of symptoms. Methods. The asymptomatic (New York Heart Association (NYHA) functional class < II) patients with chronic moderate and severe AR with normal LVEF and healthy controls were prospectively enrolled in the study. LV long axis contraction was studied using tissue Doppler (TD) and M mode echocardiography in all patients and controls. Results. The peak systolic velocities of mitral annular motion (MAM), measured by M mode and TD, and the excursion of MAM were significantly decreased in patients with severe AR compared to the controls (4,8±0,86 cm/s vs. 5,47±1,0cm/s; 7,81±1,73 vs. 9,19±1,9 cm/s; 1,39±0,19 vs. 1,53±0,18 cm respectively, p<0,05). The peak early diastolic M mode (Em) and TD (e’) velocities of MAM continued to decrease significantly depending on the severity of AR compared to controls (moderate AR group: 6,79±2,18 vs. 7,76±1,89cm/s, 9,89±3,30 vs.11,15±2,29cm/s, resp., p<0.05; severe AR group: 5,57± vs. 7,76±1,89cm/s, 8,14±2,96 vs. 11,15±2,29cm/s, resp., p<0,05) and were the best indicators of symptoms in AR patients. Conclusion. Markers of reduced long axis contraction may provide simple and reliable indices of subclinical left ventricular dysfunction and significantly predict the development of symptoms in asymptomatic severe AR patients with preserved LVEF.
Keyword(s): aortic regurgitation; mitral annular motion; left ventricular long axis contraction; systolic function; diastolic function.
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