Symptoms, left ventricular function, and timing of valve replacement surgery in patients with aortic regurgitation

Background Because cardiac decompensation is subtle, the best time to perfo rm aortic valve replacement surgery may be difficult to determine. We inves tigated the relation of symptoms to left ventricular (IV) function and the timing of valve replacement in patients with aortic regurgitation (AR) of l argely rheumatic origin. Methods Sixty-eight initially asymptomatic patients (mean age 29 years) wit h severe chronic AR were monitored for 36 months. Assessments included base line and yearly echocardiograms and radioisotope ventriculography (resting and exercise) and clinical examinations every 6 months. Results Forty-seven patients (69%) remained asymptomatic and 21 (31%) had s ymptoms develop after 24 to 36 months. Compared with symptomatic patients, asymptomatic patients had significantly (P < .05) lower baseline LV end-dia stolic diameter, end-systolic diameter, end-systolic stress, and volume/mas s ratio but greater shortening fraction and election fraction (EF) at rest. These variables remained stable without statistically significant change u ntil surgical correction in symptomatic patients. Percent variation of EF f rom rest to exercise increased in patients who remained asymptomatic (EF 2. 8% +/- 10.6%) but decreased in those who became symptomatic (EF -4.2% +/- 1 3%, P < .05). Twenty symptomatic patients (New York Heart Association class III/IV, angina and/or syncope) had valve replacement surgery, after which all were in New York Heart Association class I/II and had significant decre ases of IV end-diastolic and end-systolic diameters and an increase on perc ent variation of EF from rest to exercise (P < .0001). Conclusions Development of symptoms did not correlate with change in any ve ntricular function indexes. Surgery on appearance of symptoms restored LV f unction to near normal.