Ventricular Long-Axis Contraction as an Earlier Predictor of Outcome in Asymptomatic Aortic Regurgitation

The long-term prognostic significance of left ventricular (LV) long-axis contraction was investigated prospectively in 65 consecutive patients aged 58 ± 15 years with asymptomatic aortic regurgitation, normal LV ejection fraction at rest, and no coronary artery or aortic root disease. A complete transthoracic echocardiographic study was performed at baseline and 12 months later. In 24 of 65 patients with peak systolic wave velocity at the lateral mitral annulus (LatS) <9 cm/s, LV diameter (p <0.01), volume (p ≤0.01), mass (p <0.001), and end-systolic wall stress (p <0.001) significantly increased after 12 months, whereas LV shortening and ejection fraction (p = 0.001) and tissue Doppler right ventricular peak systolic wave velocity (p <0.05) decreased significantly. In patients with peak systolic wave velocity at the lateral mitral annulus ≥9 cm/s, none of these parameters was significantly affected during follow-up. Aortic valve replacement was performed in 6 of 24 patients (25%) with peak systolic wave velocity at the lateral mitral annulus <9 cm/s and none with peak systolic wave velocity at the lateral mitral annulus ≥9 cm/s. In patients with peak systolic wave velocity at the lateral mitral annulus <9 cm/s, a cut-off value of 6.25 cm/s predicted aortic valve replacement within the next year with 97% sensitivity and 83% specificity. In conclusion, ventricular long-axis contraction seems to be a reliable indicator for outcome prediction in patients with asymptomatic aortic regurgitation.