Diastolic Dysfunction in Aortic Regurgitation

Follow-up study in patients with severe aortic regurgitation after successful valve replacement. Systolic and diastolic function were assessed and persistent diastolic dysfunction was observed late (7-10 years) after operation.

Background Patients with severe aortic regurgitation show eccentric LV hypertrophy and structural changes of the myocardium. Reversibility of functional and structural changes after successful valve replacement may be limited. Persistent diastolic dysfunction has been observed in the present study late after aortic valve replacement. This finding has been explained by incomplete regression of the extra-cellular matrix 7 years after valve replacement. Interstitial fibrosis remains unchanged compared to the preoperative situation but was increased early after operation due to the reduction in LV muscle mass. Regression of LV hypertrophy was 40% after 2 and 55% after 7 years of valve replacement. Myocardial muscle fibers decreased slightly but remained hypertrophied even late after operation. Interstitital fibrosis was found to be positively correlated to myocardial stiffness and inversely to LV ejection fraction. Thus, persistent diastolic dysfunction with maintained systolic ejection performance can be observed late after successful valve replacement in patients with severe aortic regurgitation. Altered diastolic function has been associated with increased filling pressures during strenuous exercise with signs of dyspnea. Objective Evaluation of myocardial structure and function in patients with chronic volume overload before and after valve replacement(LV-remodeling). Methods Pressure-volume measurements and myocardial biopsy samples for assessing myocardial function and structure.

diastolic function, aortic regurgitation, aortic valve replacement, left ventricular hypertrophy, myocardial structure, LV remodeling, Muscular regression, LV fibrous tissue

Inclusion Criteria: Severe aortic regurgitation Successful valve replacement Informed consent Sinus rhythm No comorbidities No bundle branch block No pregnancy Exclusion Criteria Unwillingness to undergo postop. cath diabetes mellitus arterial hypertension bleeding disorder pulmonary hypertension

Villari B, Sossalla S, Ciampi Q, Petruzziello B, Turina J, Schneider J, Turina M, Hess OM. Persistent diastolic dysfunction late after valve replacement in severe aortic regurgitation. Circulation. 2009 Dec 8;120(23):2386-92. doi: 10.1161/CIRCULATIONAHA.108.812685. Epub 2009 Nov 23.