Left Ventricular Ejection Performance, Wall Stress, and Contractile State in Aortic Regurgitation Before and After Aortic Valve Replacement

Left ventricular ejection performance, wall stress, and contractile state were evaluated in 35 patients with chronic aortic regurgitation. Cineangiography and pressure measurements were obtained before and a mean of 26 months after aortic valve replacement, and data were compared with those from 30 normal control subjects. The relation between quantitative changes in wall stress and changes in ejection fractiopi after surgery was determined. Preoperatively, end-systolic stress was elevated in patients with aortic regurgitation (218+45 vs. 160+23 kdynes/cm2 [mean ± SD] for control subjects, p<0.01), and ejection fraction was depressed (0.46±0.11 vs. 0.65+0.05, p<0.01). End-systolic stress decreased postoperatively (151±41 kdynes/cm2, p<0.01) and ejection fraction increased (0.58±0.11, p<0.01). The magnitude of increase in ejection fraction correlated significantly and negatively (r=-0.65) with the quantitative change in end-systolic stress after surgery. Contractile function, as assessed by the ejection phase index-end-systolic stress relation, did not significantly change: 23 of35 patients preoperatively and 18 of35 patients postoperatively had values that clearly fell below the 95 % confidence limit of the ejection fraction-end-systolic stress relation for controls. After surgery, individual ejection fraction-end-systolic stress relationships demonstrated