Background: Predicting outcomes of surgical aortic valve replacement
(AVR) in patients with chronic severe aortic regurgitation (AR) and markedly
reduced left ventricular (LV) function remains a challenge. This study aimed to
explore the preoperative echocardiographic index that could predict the recovery
of LV systolic function after surgery in patients with chronic severe AR and
reduced left ventricular ejection fraction (LVEF). Methods: The study
group consisted of 50 patients diagnosed with chronic severe AR (6 months) and
significantly reduced LVEF (18~35%, average 26.2 5.3%).
Low-dose dobutamine stress echocardiography (DSE) was performed before surgery.
Only patients with an absolute increase in LVEF 8% during DSE were
referred for surgical AVR. During following up (over six months to one year after
surgery), the patients were divided into two groups by postoperative LVEF ( or
40%). DSE- and speckle tracking echocardiography (STE)-derived LV
functional parameters were compared between groups to identify predictors of
post-operative improvement in LVEF. Results: A total of 38 patients
underwent AVR. One patient died before discharge. Post-surgical LV size and LVEF
improved markedly after surgery in all patients (n = 37). Pre-surgical LV
end-systolic diameter, baseline global longitudinal strain (GLS) and peak GLS
were better in the group with LVEF 40% (n = 18; p 0.05,
t test). Baseline GLS and peak GLS correlated moderately with
post-surgery LVEF (R = –0.581, p 0.001; R = –0.596, p
0.001; respectively). Logistic regression analysis demonstrated baseline GLS and
peak GLS were the independent predictors of post-surgery improvement of LVEF.
Peak GLS had the highest prediction value (area under the curve = 0.895, sensitivity and
specificity: 89.5% and 77.8%, respectively), with a cutoff value of –9.4%.
Conclusions: This study shows that STE combined with DSE can provide
sensitive quantitative indices for predicting improvement of LV systolic function
after AVR in patients with chronic severe AR and significantly decreased LVEF.