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Prediction of left ventricular systolic dysfunction after 6 months of aortic valve replacement in patients with chronic severe aortic regurge 

Journal of Cardiology & Current Research
Mohammad Gouda, Ahmed S Ammar Mohammad Hassan, MF Abdel-Alwahab

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Introduction: LVEF as a surrogate for myocardial performance is problematic in chronic AR as it is augmented by increased preload. Therefore, we need noninvasive parameters to assess myocardial function in altered loading conditions. We aim to assess the validity of new echo-Doppler indices for prediction of postoperative LV dysfunction 6 months after AVR. 
Methods: We recruited 20 patients with severe isolated AR with LVEF >50%, prepared for AVR. Echocardiographic examination was done 48hours before and 6 months after AVR. Early diastolic driving force "DF", Global longitudinal strain "GLS" and Left ventricular ejection fraction "LVEF" by modified biplane Simpson method were measured. Our patients were classified according to postoperative LVEF into Group A (15 cases); normal (postoperative LVEF≥50%) and Group B (5 cases); postoperative LV systolic dysfunction (postoperative LVEF<50%).
Results: preoperative DF was 0.20±0.12 Newton in group A while it was 0.66±0.28 Newton in group B, this difference was statistically significant (t=3.5, p<0.05). EF was 62.73±6.64% in-group A while it was 53.2±2.77% in-group B, this difference was statistically highly significant (t=4.50, p<0.001). GLS was -18.95±2.55% in-group A while it was -12.56±2.04% in group B, this difference was statistically highly significant (t=5.04, p<0.001). On plotting the ROC curves, it was clear that preoperative GLS and DF are strong predictors of post-operative systolic dysfunction in such cases.
Conclusion: Preoperative GLS and DF seem to be independent predictors for postoperative LV systolic dysfunction after AVR for chronic severe AR.


AVR, severe aortic valve regurgitation, LV, left ventricular, LVFR, Left ventricular ejection fraction, GLS, global longitudinal strain, DT, deceleration time, ROC, receiver operating characteristic, DF, driving force, LRA, logistic regression analysis, aortic regurgitation, aortic valve replacement, color doppler, diastolic function