Usefulness of left ventricular wall stress at rest and after exercise for outcome prediction in asymptomatic aortic regurgitation

Abstract

Sensitive indexes for detection of left ventricular (LV) systolic performance are necessary for optimal clinical management of asymptomatic patients with aortic regurgitation (AR). To investigate the prognostic value of noninvasively determined baseline LV wall stress, we studied 10 asymptomatic patients with AR who had normal LV systolic function on two-dimensional directed M-mode echocardiography at rest and after maximal treadmill exercise. At follow-up (mean 3.6 years) three patients (group A) had progressed to decompensated LV volume overload or death related to aortic valve disease (one cardiac death and two aortic valve replacements), and seven patients (group B) remained unchanged clinically and on serial echocardiographic study. Although baseline LV chamber dimensions and systolic performance at rest were similar in the two groups of patients, LV fractional shortening after exercise and LV wall stress at rest and after exercise were significantly different (p = 0.02). Noninvasively determined baseline LV wall stress at rest and after exercise may be useful indexes for determining prognosis in asymptomatic AR.