LEFT-VENTRICULAR FUNCTION IN PATIENTS WIT H POST-ENDOCARDITIC AORTIC REGURGITATION AND AORTOANNULLAR DILATATION

Background: The duration of valvular regurgitation is an important det erminant of left ventricular function in the presence of severe volume overload. Purpose: To evaluate the effect of aortic regurgitation (ao rtoannullar dilatation vs. history of bacterial endocarditis) on left ventricular (LV) function. Patients: Between February 1976 and January 1993 45 patients (mean; age 45+/-12 years) underwent diagnostic evalu ation for clinical purposes. Patients were divided into three groups: group 1 consisted of 17 patients with normal LV function (controls), g roup 2 of 11 patients with severe aortic regurgitation due to aortoann ullar dilatation (AAD) and group 3 of patients with severe aortic regu rgitation and a history of bacterial endocarditis (BE). Methods: LV fu nction was assessed by biplane LV-angiography and simultaneous pressur e recordings. The ejection fraction and peak systolic wall stress were calculated in all patients. Systolic and diastolic LV function was de termined and compared within the three groups. Results: Heart rate, me an aortic pressure and cardiac index were similar in the three groups. The mean aortic diameter was significantly increased in group 2 when compared to the other two groups (p <0,001). Systolic function was sig nificantly reduced in both groups with aortic regurgitation when compa red to the control patients. The enddiastolic pressure-volume relation ship was shifted to the right in patients with aortic regurgitation, b ut only 3 patients with a history of bacterial endocarditis showed sev ere diastolic dysfunction. Conclusions: No hemodynamic differences wer e observed in patients with severe aortic regurgitation with regard to the etiology or time course of LV volume overload. However, 17% of th e patients with a history of bacterial endocarditis had severe diastol ic dysfunction, which is probably due to the faster development of vol ume overload after bacterial endocarditis.