ABSTRACT
Objective: Predictors for post-operative reverse remodeling in
patients with severe aortic regurgitation (AR) and reduced left
ventricular ejection fraction (LVEF) are unknown. We performed low-dose
dobutamine stress echocardiography (DSE) in patients with severe AR and
reduced LVEF to evaluate the relationship between contractile reserve
(CR) and reverse remodeling after surgery.
Methods: In 31 patients with chronic severe AR and reduced LVEF
(LVEF < 50%), we performed pre-operative DSE, assessed CR and
examined whether changes in preoperative DSE were associated with
improvement of post-operative LVEF after aortic valve surgery.
Results: The pre-operative echocardiographic findings were as
follows: left ventricular (LV) end-diastolic dimension: 67 ± 10 mm, LV
end-systolic dimension: 52 ± 13 mm and LVEF: 42% ± 8%. All patients
underwent aortic valve surgery. Patients with pre-operative LVEF of> 45% exhibited a significant increase in LVEF;
however, patients with pre-operative LVEF of <45% showed no
significant change. When we examined the results of DSE performed in
patients with pre-operative LVEF of <45%, ΔLVEF of ≥6% (with
CR) during DSE was related to an improvement in post-operative LVEF;
ΔLVEF of ≥6% during DSE predicted an improvement in post-operative
LVEF, with a sensitivity and specificity of 80% and 85%, respectively.
Conclusions: DSE may be a helpful tool for predicting
post-operative reverse remodeling in patients with severe AR and
moderately reduced LVEF.
Key Words: aortic regurgitation, dobutamine stress
echocardiography, aortic valve replacement, reverse remodeling