Natural history of left ventricular performance at rest and during exercise after aortic valve replacement for aortic regurgitation
Borer, J.S.; Herrold, E.M.; Hochreiter, C.; Roman, M.; Supino, P.; Devereux, R.B.; Kligfield, P.; Nawaz, H.
Circulation 84(5): III133-III139
1991
ISSN/ISBN: 0009-7322 PMID: 1934401 Document Number: 371345
Previous studies of left ventricular performance in aortic regurgitation uniformly indicate improvement within the year after aortic valve replacement but differ regarding the likelihood of additional later improvement. To resolve this difference, to more precisely define the pattern of postoperative left ventricular performance variation, and to assess the impact of valve replacement on ejection fraction during exercise, we evaluated radionuclide cineangiograms obtained annually or nearly annually for approximately 5 years in 21 prospectively studied patients who had undergone valve replacement for aortic regurgitation. Ejection fraction rose from < 8 months before operation to 5-11 (average 7) months after operation and continued to rise for 1 additional year (rest) and 2 additional years (exercise) before reaching a stable plateau until the final study 54-72 (average 63) months postoperatively. Mean ejection fractions at rest were 45% preoperatively, 50% < 1 year postoperatively (p = 0.12), 54% at year 1-2 (p = 0.01 versus < 1 year), 56% at year 2-3 (NS versus year 1-2) and year 4-6 (NS versus year 1-2 or 2-3), and during exercise were 39% preoperatively, 49% < 1 year postoperatively (p < 0.01), 54% at year 1-2 (p < 0.01 versus < 1 year, NS versus year 2-3, p < 0.05 versus year 4-6), 60% at year 2-3, and 61% at year 4-6 (NS versus year 2-3). Late improvement was found most consistently among patients with relatively depressed performance before operation. Thus, left ventricular performance predictably improves progressively for 2 years (rest) and 3 years (exercise) after valve replacement; late improvement is most marked during exercise. The plateau reached 3 years after operation is stable, and subsequent deterioration is highly unlikely in the absence of new valve dysfunction or unrelated disease.