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British Heart Journal logoLink to British Heart Journal
. 1984 Sep;52(3):284–291. doi: 10.1136/hrt.52.3.284

Relation of midwall circumferential systolic stress to equatorial midwall fibre shortening in chronic aortic regurgitation. Value as a predictor of postoperative outcome.

P Almeida, M Córdoba, J Goicolea, R Hernández Antolín, L A Rico, M Rey, P Rábago, G Rábago
PMCID: PMC481626  PMID: 6235830

Abstract

Nineteen patients with chronic aortic regurgitation and a large increase in heart size were studied before aortic valve replacement. By relating midwall circumferential systolic stress to midwall circumferential fibre shortening (Cs/Cd) before operation the patients could be divided into two well defined groups. Twelve patients (group 1) had a pronounced decrease in heart size as measured by the cardiothoracic ratio and an excellent clinical outcome six months after operation. Seven patients (group 2) had no significant decrease in heart size and a less good clinical outcome. The ratio of midwall circumferential systolic stress to end systolic volume index was significantly higher in group 1 than in group 2. Group 2 had more severe left ventricular hypertrophy determined by the ratio of the wall thickness to the minor internal radius of the left ventricle (h:r ratio), total left ventricular mass, and left ventricular mass to end diastolic volume ratio. There were no significant differences in any other haemodynamic or angiographic indices between the two groups. Thus the relation of midwall circumferential systolic stress to fibre shortening is useful in determining the prognosis in individual patients with chronic aortic regurgitation undergoing aortic valve replacement.

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Selected References

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  1. Almeida Vergara P., Córdoba Polo M., López Mínquez J. R., Sokolowski Filip M., de Rábago González P. Localización del centro geométrico del ventrículo izquierdo y sus aplicaciones a la angiocardiografía cuantitativa. Rev Esp Cardiol. 1982;35(3):265–269. [PubMed] [Google Scholar]
  2. Bolen J. L., Holloway E. L., Zener J. C., Harrison D. C., Alderman E. L. Evaluation of left ventricular function in patients with aortic regurgitation using afterload stress. Circulation. 1976 Jan;53(1):132–138. doi: 10.1161/01.cir.53.1.132. [DOI] [PubMed] [Google Scholar]
  3. Bonow R. O., Borer J. S., Rosing D. R., Henry W. L., Pearlman A. S., McIntosh C. L., Morrow A. G., Epstein S. E. Preoperative exercise capacity in symptomatic patients with aortic regurgitation as a predictor of postoperative left ventricular function and long-term prognosis. Circulation. 1980 Dec;62(6):1280–1290. doi: 10.1161/01.cir.62.6.1280. [DOI] [PubMed] [Google Scholar]
  4. Bonow R. O., Rosing D. R., Kent K. M., Epstein S. E. Timing of operation for chronic aortic regurgitation. Am J Cardiol. 1982 Aug;50(2):325–336. doi: 10.1016/0002-9149(82)90184-9. [DOI] [PubMed] [Google Scholar]
  5. Bonow R. O., Rosing D. R., McIntosh C. L., Jones M., Maron B. J., Lan K. K., Lakatos E., Bacharach S. L., Green M. V., Epstein S. E. The natural history of asymptomatic patients with aortic regurgitation and normal left ventricular function. Circulation. 1983 Sep;68(3):509–517. doi: 10.1161/01.cir.68.3.509. [DOI] [PubMed] [Google Scholar]
  6. Borow K. M., Green L. H., Grossman W., Braunwald E. Left ventricular end-systolic stress-shortening and stress-length relations in human. Normal values and sensitivity to inotropic state. Am J Cardiol. 1982 Dec;50(6):1301–1308. doi: 10.1016/0002-9149(82)90467-2. [DOI] [PubMed] [Google Scholar]
  7. Borow K. M., Green L. H., Mann T., Sloss L. J., Braunwald E., Collins J. J., Cohn L., Grossman W. End-systolic volume as a predictor of postoperative left ventricular performance in volume overload from valvular regurgitation. Am J Med. 1980 May;68(5):655–663. doi: 10.1016/0002-9343(80)90251-x. [DOI] [PubMed] [Google Scholar]
  8. Bristow J. D., Kremkau E. L. Hemodynamic changes after valve replacement with Starr-Edwards prostheses. Am J Cardiol. 1975 May;35(5):716–724. doi: 10.1016/0002-9149(75)90064-8. [DOI] [PubMed] [Google Scholar]
  9. Burggraf G. W., Craige E. Echocardiographic studies of left ventricular wall motion and dimensions after valvular heart surgery. Am J Cardiol. 1975 Apr;35(4):473–480. doi: 10.1016/0002-9149(75)90829-2. [DOI] [PubMed] [Google Scholar]
  10. Carabello B. A., Gash A., Mayers D., Spann J. F. Normal left ventricular systolic function in adults with atrial septal defect and left heart failure. Am J Cardiol. 1982 Jun;49(8):1868–1873. doi: 10.1016/0002-9149(82)90204-1. [DOI] [PubMed] [Google Scholar]
  11. Carabello B. A., Nolan S. P., McGuire L. B. Assessment of preoperative left ventricular function in patients with mitral regurgitation: value of the end-systolic wall stress-end-systolic volume ratio. Circulation. 1981 Dec;64(6):1212–1217. doi: 10.1161/01.cir.64.6.1212. [DOI] [PubMed] [Google Scholar]
  12. Clark D. G., McAnulty J. H., Rahimtoola S. H. Valve replacement in aortic insufficiency with left ventricular dysfunction. Circulation. 1980 Feb;61(2):411–421. doi: 10.1161/01.cir.61.2.411. [DOI] [PubMed] [Google Scholar]
  13. Clark R. D., Korcuska K., Cohn K. Serial echocardiographic evaluation of left ventricular function in valvular disease, including reproducibility guidelines for serial studies. Circulation. 1980 Sep;62(3):564–575. doi: 10.1161/01.cir.62.3.564. [DOI] [PubMed] [Google Scholar]
  14. Cunha C. L., Giuliani E. R., Fuster V., Seward J. B., Brandenburg R. O., McGoon D. C. Preoperative M-mode echocardiography as a predictor of surgical results in chronic aortic insufficiency. J Thorac Cardiovasc Surg. 1980 Feb;79(2):256–265. [PubMed] [Google Scholar]
  15. Gaasch W. H., Andrias C. W., Levine H. J. Chronic aortic regurgitation: the effect of aortic valve replacement on left ventricular volume, mass and function. Circulation. 1978 Nov;58(5):825–836. doi: 10.1161/01.cir.58.5.825. [DOI] [PubMed] [Google Scholar]
  16. Grossman W., Braunwald E., Mann T., McLaurin L. P., Green L. H. Contractile state of the left ventricle in man as evaluated from end-systolic pressure-volume relations. Circulation. 1977 Nov;56(5):845–852. doi: 10.1161/01.cir.56.5.845. [DOI] [PubMed] [Google Scholar]
  17. Henry W. L., Bonow R. O., Borer J. S., Ware J. H., Kent K. M., Redwood D. R., McIntosh C. L., Morrow A. G., Epstein S. E. Observations on the optimum time for operative intervention for aortic regurgitation. I. Evaluation of the results of aortic valve replacement in symptomatic patients. Circulation. 1980 Mar;61(3):471–483. doi: 10.1161/01.cir.61.3.471. [DOI] [PubMed] [Google Scholar]
  18. Henry W. L., Bonow R. O., Rosing D. R., Epstein S. E. Observations on the optimum time for operative intervention for aortic regurgitation. II. Serial echocardiographic evaluation of asymptomatic patients. Circulation. 1980 Mar;61(3):484–492. doi: 10.1161/01.cir.61.3.484. [DOI] [PubMed] [Google Scholar]
  19. Hirota Y., Furubayashi K., Kaku K., Shimizu G., Kino M., Kawamura K., Takatsu T. Hypertrophic nonobstructive cardiomyopathy: a precise assessment of hemodynamic characteristics and clinical implications. Am J Cardiol. 1982 Nov;50(5):990–997. doi: 10.1016/0002-9149(82)90407-6. [DOI] [PubMed] [Google Scholar]
  20. Hirshfeld J. W., Jr, Epstein S. E., Roberts A. J., Glancy D. L., Morrow A. G. Indices predicting long-term survival after valve replacement in patients with aortic regurgitation and patients with aortic stenosis. Circulation. 1974 Dec;50(6):1190–1199. doi: 10.1161/01.cir.50.6.1190. [DOI] [PubMed] [Google Scholar]
  21. Hugenholtz P. G., Kaplan E., Hull E. Determination of left ventricular wall thickness by angiocardiography. Am Heart J. 1969 Oct;78(4):513–522. doi: 10.1016/0002-8703(69)90486-4. [DOI] [PubMed] [Google Scholar]
  22. Johnson A. D., Alpert J. S., Francis G. S., Vieweg V. R., Ockene I., Hagan A. D. Assessment of left ventricular function in severe aortic regurgitation. Circulation. 1976 Dec;54(6):975–979. doi: 10.1161/01.cir.54.6.975. [DOI] [PubMed] [Google Scholar]
  23. Krayenbuehl H. P., Hess O. M., Schneider J., Turina M. Physiologic or pathologic hypertrophy. Eur Heart J. 1983 Jan;4 (Suppl A):29–34. doi: 10.1093/eurheartj/4.suppl_a.29. [DOI] [PubMed] [Google Scholar]
  24. Kumpuris A. G., Quinones M. A., Waggoner A. D., Kanon D. J., Nelson J. G., Miller R. R. Importance of preoperative hypertrophy, wall stress and end-systolic dimension as echocardiographic predictors of normalization of left ventricular dilatation after valve replacement in chronic aortic insufficiency. Am J Cardiol. 1982 Apr 1;49(5):1091–1100. doi: 10.1016/0002-9149(82)90032-7. [DOI] [PubMed] [Google Scholar]
  25. Marsh J. D., Green L. H., Wynne J., Cohn P. F., Grossman W. Left ventricular end-systolic pressure-dimension and stress-length relations in normal human subjects. Am J Cardiol. 1979 Dec;44(7):1311–1317. doi: 10.1016/0002-9149(79)90446-6. [DOI] [PubMed] [Google Scholar]
  26. McDonald I. G., Jelinek V. M. Serial M-mode echocardiography in severe chronic aortic regurgitation. Circulation. 1980 Dec;62(6):1291–1296. doi: 10.1161/01.cir.62.6.1291. [DOI] [PubMed] [Google Scholar]
  27. Mehmel H. C., Mazzoni S., Krayenbuehl H. P. Contractility of the hypertrophied human left ventricle in chronic pressure and volume overload. Am Heart J. 1975 Aug;90(2):236–240. doi: 10.1016/0002-8703(75)90125-8. [DOI] [PubMed] [Google Scholar]
  28. Mehmel H. C., Stockins B., Ruffmann K., von Olshausen K., Schuler G., Kübler W. The linearity of the end-systolic pressure-volume relationship in man and its sensitivity for assessment of left ventricular function. Circulation. 1981 Jun;63(6):1216–1222. doi: 10.1161/01.cir.63.6.1216. [DOI] [PubMed] [Google Scholar]
  29. Mirsky I., Henschke C., Hess O. M., Krayenbuehl H. P. Prediction of postoperative performance in aortic valve disease. Am J Cardiol. 1981 Aug;48(2):295–303. doi: 10.1016/0002-9149(81)90610-x. [DOI] [PubMed] [Google Scholar]
  30. Mirsky I. Left ventricular stresses in the intact human heart. Biophys J. 1969 Feb;9(2):189–208. doi: 10.1016/S0006-3495(69)86379-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Osbakken M., Bove A. A., Spann J. F. Left ventricular function in chronic aortic regurgitation with reference to end-systolic pressure, volume and stress relations. Am J Cardiol. 1981 Feb;47(2):193–198. doi: 10.1016/0002-9149(81)90383-0. [DOI] [PubMed] [Google Scholar]
  32. Toussaint C., Cribier A., Cazor J. L., Soyer R., Letac B. Hemodynamic and angiographic evaluation of aortic regurgitation 8 and 27 months after aortic valve replacement. Circulation. 1981 Sep;64(3):456–463. doi: 10.1161/01.cir.64.3.456. [DOI] [PubMed] [Google Scholar]
  33. Trenouth R. S., Phelps N. C., Neill W. A. Determinants of left ventricular hypertrophy and oxygen supply in chronic aortic valve disease. Circulation. 1976 Apr;53(4):644–650. doi: 10.1161/01.cir.53.4.644. [DOI] [PubMed] [Google Scholar]
  34. Venco A., St John Sutton M. G., Gibson D. G., Brown D. J. Non-invasive assessment of left ventricular function after correction of severe aortic regurgitation. Br Heart J. 1976 Dec;38(12):1324–1331. doi: 10.1136/hrt.38.12.1324. [DOI] [PMC free article] [PubMed] [Google Scholar]

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