Evaluation of the response to pharmacological stress in chronic aortic regurgitation

We evaluated the hemodynamic response of patients with chronic aortic regur gitation and decreased ejection fraction (EF), mean value +/- SD (37 +/- 9) , to dobutamine stress echocardiography (DSE). Eleven patients were studied with DSE. Nine patients were in New York Heart Association (NYHA) Class II and two in NYHA Class Ill. Ten patients received medical treatment in the only other periodic evaluation. With DSE in nine patients, a significant de crease in left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD) as well as LV end-diastolic and end-systolic volumes (LVEDV and LVESV) was documented in comparison to resting values. EF and fractional sh ortening (FS) improved significantly with DSE. Systolic wall stress (SWS) a nd pulmonary arterial systolic pressure (PASP) did not change. Average foll ow-up was 6.7 months. Three patients underwent valve replacement with mecha nical prostheses. Two of them are in NYHA Class I and the other died of LV failure 3 days after surgery. One patient deteriorated beyond surgical trea tment and was in NYHA Class II. The other seven patients remain in NYHA Cla ss Il and await valve replacement. In patients with chronic aortic regurgit ation and depressed EF, the variables relevant to myocardial reserve appear to be EF, FS, LVEDD, LVESD, LVEDV, and LVESV.