Use of left ventricular filling and ejection patterns in assessing severity of chronic mitral and aortic regurgitation

Abstract

To determine whether left ventricular (LV) filling and ejection patterns can be used to characterize the severity of mitral and aortic regurgitation (MR and AR), normalized volume vs time curves derived from left ventriculograms were plotted using a computer-based image analysis system. These patterns were measured in 20 normal subjects, 14 patients with MR and 21 patients with AR. In addition, timeaveraged volume changes (dV/dt) and diameter changes (dD/dt), stroke or filling volume, and ejection or filling fraction were measured during systole and diastole. The patients with volume overload were separated into 4 groups based on symptoms: asymptomatic (MR, 7 patients, AR, 10 patients); congestive heart failure (CHF) (MR, 7 patients, AR, 11 patients). Ejection fraction was significantly depressed in both CHF groups, even though stroke volume index was significantly increased in all groups. The temporal pattern of diastolic filling in patients with CHF secondary to MR and AR demonstrated slower, later diastolic filling compared with normal subjects, while in asymptomatic MR, diastolic filling was more rapid than in normal subjects. Diastolic filling patterns were similar to normal in asymptomatic AR patients. Temporal systolic emptying was slower in patients with CHF secondary to AR; emptying patterns in asymptomatic MR patients were similar to those of normal subjects; late systolic emptying was accelerated in patients with asymptomatic AR. Thus, there were filling and emptying abnormalities in all stages of volume overload secondary to regurgitation. These values can be measured noninvasively with scintigraphic angiography and echocardiography and may be useful as indicators of progressive ventricular dysfunction in patients with chronic valvular regurgitation.