Rest versus Exercise Ejection Fraction and the Decision to Perform Valve Replacement in Aortic Regurgitation

Abstract

To study the relationship between left ventricular ejection fraction (LVEF) and the decision to perform aortic valve replacement, the correlates of undergoing valve replacement were studied in 56 asymptomatic or mildly symptomatic patients with isolated severe chronic aortic regurgitation (AR) undergoing exercise radionuclide angiography. The need for valve replacement was not indicated on clinical grounds, because symptoms were either mild or absent. Of a variety of noninvasive laboratory variables, stepwise logistic regression analysis showed the rest LVEF to be the best correlate of performing valve replacement. Valve replacement was performed in 24 (43 %) of the patients including 5% of AR patients with rest LVEF of 0.50 or more, 40% of patients with rest LVEF of 0.41-0.49, and 88% of patients with rest LVEF of 0.40 or less, p < 0.001. Of the 20 patients within the intermediate rest LVEF range of 0.41-0.49, the 8 undergoing valve replacement had a similar rest LVEF, but a lower exercise LVEF and older age, compared to the 12 not undergoing valve replacement. In conclusion, rest LVEF alone strongly correlates with the decision to perform valve replacement in asymptomatic or mildly symptomatic AR. In the higher and lower LVEF ranges, the rest value is the best correlate of whether the patient will have surgery and little or no additonal information is provided by exercising the patient. Only in the intermediate LVEF range is this decision unpredictable by the rest value. Physicians appear to consider rest LVEF a powerful prognosticator as evidenced by the decision-making patterns observed.