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Preoperative left ventricular energy loss in the operating theater reflects subjective symptoms in chronic aortic regurgitation
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  • Atsushi Kainuma,
  • Keiichi Itatani,
  • Koichi Akiyama,
  • Yoshifumi Naito,
  • Maki Ishii,
  • Masaru Shimizu,
  • Junya Ohara,
  • Naotoshi Nakamura,
  • Yasufumi Nakajima,
  • Satoshi Numata,
  • Hitoshi Yaku,
  • Teiji Sawa
Atsushi Kainuma
Kyoto Prefectural University of Medicine
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Keiichi Itatani
Kyoto Prefectural University of Medicine
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Koichi Akiyama
Kyoto Prefectural University of Medicine
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Yoshifumi Naito
Kyoto Prefectural University of Medicine
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Maki Ishii
Kyoto Prefectural University of Medicine
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Masaru Shimizu
Kyoto Prefectural University of Medicine
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Junya Ohara
Kyoto Prefectural University of Medicine
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Naotoshi Nakamura
Osaka University
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Yasufumi Nakajima
Kansai Medical University
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Satoshi Numata
Kyoto Prefectural University of Medicine
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Hitoshi Yaku
Kyoto Prefectural University of Medicine
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Teiji Sawa
Kyoto Prefectural University of Medicine
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Abstract

Objective: There is currently no subjective, definitive evaluation method for therapeutic indication other than symptoms in aortic regurgitation. Energy loss, a novel parameter of cardiac workload, can be visualized and quantified using echocardiography vector flow mapping. The purpose of the present study was to evaluate whether energy loss in patients with chronic aortic regurgitation can quantify their subjective symptoms more clearly than other conventional metrics. Methods: We studied 15 patients undergoing elective aortic valve surgery for aortic regurgitation. We divided the patients into symptomatic and asymptomatic groups using their admission records. We analyzed the mean energy loss in one cardiac cycle using transesophageal echocardiography during the preoperative period. The relationships between symptoms, energy loss, and other conventional metrics were statistically analyzed. Results: There were seven and eight patients in the symptomatic and asymptomatic groups, respectively. The mean energy loss of one cardiac cycle was higher in the symptomatic group (121 [96 to 184]) than in the asymptomatic group (87 [80 to 103]) (p=0.040), whereas the diastolic diameter was higher in the asymptomatic group (65 [59 to 78]) than in the symptomatic group (57 [51 to 57]) (p=0.040). There was no significant difference between the symptomatic and asymptomatic groups in terms of other conventional metrics. Conclusions: An energy loss can quantify patients’ subjective symptoms more clearly than other conventional metrics. The small sample size is the primary limitation of our study, further studies assessing larger cohort of patients are warranted to validate our findings.

Peer review status:UNDER REVIEW

19 Aug 2020Submitted to Journal of Cardiac Surgery
20 Aug 2020Assigned to Editor
20 Aug 2020Submission Checks Completed
25 Aug 2020Reviewer(s) Assigned