Heart 2001;85:30-36 ( January )

Cardiovascular medicine

Assessment of left ventricular long axis contraction can detect early myocardial dysfunction in asymptomatic patients with severe aortic regurgitation D Vinereanu, A A Ionescu, A G Fraser

Cardiovascular Sciences Research Group, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK

Correspondence to: Dr Fraser fraserag{at}cf.ac.uk

Accepted 12 September 2000

OBJECTIVETo identify variables that could be applied at rest to diagnose subclinical ventricular dysfunction in asymptomatic patients with severe aortic regurgitation.
DESIGNCross sectional study.
PATIENTSLeft ventricular long axis contraction was studied using tissue Doppler and M mode echocardiography in 21 patients with no symptoms (New York Heart Association (NYHA) functional class 2a) but severe aortic regurgitation (jet area/left ventricular outflow tract area > 40%).
MAIN OUTCOME MEASURESLeft ventricular ejection fraction (LVEF) at baseline and peak exercise (Weber protocol), cardiopulmonary function, and left ventricular long axis function at rest (peak systolic velocity and excursion of the mitral annulus).
RESULTSIn 11 patients, ejection fraction increased or did not change (from mean (SD) 55 (5)% to 58 (4)%, p < 0.05) (group I); in 10 patients it decreased by > 5% (from 54 (4)% to 42 (5)%, p < 0.001) (group II). Exercise ejection fraction was < 50% in all patients in group II. At rest, there were no differences between the groups in ejection fraction, left ventricular diameter indices, wall stress, and short axis contraction. However, patients in group II had reduced long axis contraction compared with group I: peak systolic velocity 8.6 (0.6) v 11.9 (2.2) cm/s (p < 0.001); excursion 11 (2) v 14 (2) mm (p < 0.01). A resting velocity of < 9.5 cm/s was the best indicator of poor exercise tolerance (sensitivity 90%, specificity 100%).
CONCLUSIONSMarkers of reduced long axis contraction may provide simple and reliable indices of subclinical left ventricular dysfunction in asymptomatic patients with severe aortic regurgitation.


Keywords: aortic regurgitation; long axis function; tissue Doppler echocardiography; exercise echocardiography

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© 2001 by Heart
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