Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation
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RESEARCH
Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation Research
Seth Uretsky*1, Azhar Supariwala1, Puspalatha Nidadovolu1, Surinder S Khokhar1, Cindy Comeau2, Oleg Shubayev2, Francesca Campanile2 and Steven D Wolff2
Abstract Background: The treatment of patients with aortic regurgitation (AR) or mitral regurgitation (MR) relies on the accurate assessment of the severity of the regurgitation as well as its effect on left ventricular (LV) size and function. Cardiovascular Magnetic Resonance (CMR) is an excellent tool for quantifying regurgitant volumes as well as LV size and function. The 2008 AHA/ACC management guidelines for the therapy of patients with AR or MR only describe LV size in terms of linear dimensions (i.e. end-diastolic and end-systolic dimension). LV volumes that correspond to these linear dimensions have not been published in the peer-reviewed literature. The purpose of this study is to determine the effect of regurgitant volume on LV volumes and chamber dimensions in patients with isolated AR or MR and preserved LV function. Methods: Regurgitant volume, LV volume, mass, linear dimensions, and ejection fraction, were determined in 34 consecutive patients with isolated AR and 23 consecutive patients with MR and no other known cardiac disease. Results: There is a strong, linear relationship between regurgitant volume and LV end-diastolic volume index (aortic regurgitation r2 = 0.8, mitral regurgitation r2 = 0.8). Bland-Altman analysis of regurgitant volume shows little interobserver variation (AR: 0.6 ± 4 ml; MR 4 ± 6 ml). The correlation is much poorer between regurgitant volume and commonly used clinical linear measures such as end-systolic dimension (mitral regurgitation r2 = 0.3, aortic regurgitation r2 = 0.5). For a given regurgitant volume, AR causes greater LV enlargement and hypertrophy than MR. Conclusion: CMR is an accurate and robust technique for quantifying regurgitant volume in patients with AR or MR. Ventricular volumes show a stronger correlation with regurgitant volume than linear dimensions, suggesting LV volumes better reflect ventricular remodeling in patients with isolated mitral or aortic regurgitation. Ventricular volumes that correspond to published recommended linear dimensions are determined to guide the timing of surgical intervention. Introduction The timing of surgical intervention for patients with mitral or aortic regurgitation often depends on the accurate assessment of the severity of the valvular insufficiency and its effect on left ventricular (LV) size [1,2]. Two-dimensional transthoracic and transesophageal echocardiography are most commonly used to assess mitral and aortic regurgitation. Published guidelines recommend the use of LV ejection fraction as well as linear measurements such as LV end-diastolic dimension (EDD) * Correspondence: [email protected] 1
Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surge
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