Left ventricular regional wall motion and velocity of shortening in chronic mitral and aortic regurgitation

Abstract

Left ventricular regional wall motion (percent systolic shortening) and velocity of shortening were studied in patients with heart failure due to chronic volume overloads of mitral and aortic regurgitation. Biplane left ventriculograms were analyzed by computer and divided into four regions: anterior, inferior, posterolateral and septal. The study patients included 12 normal subjects; 21 patients with aortic regurgitation (10 asymptomatic and 11 with congestive heart failure); and 11 patients with mitral regurgitation (4 asymptomatic and 7 with congestive heart failure). No patient had coronary artery disease. With heart failure, ejection fraction was decreased (p <0.05) in both aortic and mitral regurgitation (normal 62 ± 3 percent [mean ± standard error of the mean], aortic regurgitation 48 ± 3 and mitral regurgitation 51 ± 5). In mitral regurgitation with heart failure, the percent segment shortening in anterior (normal 42 ± 2, mitral regurgitation 27 ± 5) and posterolateral (normal 23 ± 3, mitral regurgitation 16 ± 4) regions was significantly decreased (p <0.05), whereas this value in the inferior (normal 32 ± 2, mitral regurgitation 28 ± 6) and septal (normal 46 ± 4, mitral regurgitation 47 ± 5) regions was normal. In aortic regurgitation with heart failure, anterior (27 ± 2), inferior (17 ± 3) and septal (5 ± 1) segment shortening was significantly decreased, whereas posterolateral segment shortening was normal (24 ± 3). In both groups with heart failure, mean shortening velocity showed regional variations similar to those of percent shortening, whereas peak instantaneous shortening velocity was not reduced in mitral regurgitation compared with normal values. In the asymptomatic group, shortening and mean shortening velocity were normal, whereas peak instantaneous shortening velocity was increased in mitral regurgitation. In aortic and mitral regurgitation with decreased left ventricular function demonstrated by a reduced ejection fraction, there are regional wall motion abnormalities that are not caused by coronary disease.