Assessment of left ventricular long axis contraction can detect early myocardial dysfunction in asymptomatic patients with severe aortic regurgitation

Objective-To identify variables that could be applied at rest to diagnose s ubclinical. ventricular dysfunction in asymptomatic patients with severe ao rtic regurgitation. Design-Cross sectional study. Patients-Left ventricular long axis contraction was studied using tissue Do ppler and M mode echocardiography in 21 patients with no symptoms (New York Heart Association (NYHA) functional class less than or equal to 2a) but se vere aortic regurgitation (jet area/left ventricular outflow tract area > 4 0%). Main outcome measures-left: ventricular ejection fraction (LVEF) at baselin e and peak exercise (Weber protocol), cardiopulmonary function, and left: v entricular long axis function at rest (peak systolic velocity and excursion of the mitral annulus). Results-In 11 patients, ejection fraction increased or did not change (from mean (SD) 55 (5)% to 58 (4)%, p < 0.05) (group I); in 10 patients it decre ased by > 5% (from 54 (4)% to 4 2 (5)%, p < 0.001) (group II). Exercise eje ction fraction was < 50% in all patients in group II. At rest, there were n o differences between the groups in ejection fraction, left ventricular dia meter indices, wall stress, and short axis contraction. However, patients i n group II had reduced long axis contraction compared with group I: peak sy stolic velocity 8.6 (0.6) v 11.9 (2.2) cm/s (p < 0.001); excursion 11 (2) v 14 (2) mm (p < 0.01). A resting velocity of < 9.5 cm/s was the best indica tor of poor exercise tolerance (sensitivity 90%, specificity 100%). Conclusions-Markers of reduced long axis contraction may provide simple and reliable indices of subclinical left ventricular dysfunction in asymptomat ic patients with severe aortic regurgitation.