Differences in myocardial performance and load between patients with similar amounts of chronic aortic versus chronic mitral regurgitation
T Wisenbaugh,
JF Spann,
and
BA Carabello
It is not known if the favorable changes in preload and afterload that augment ejection performance in acute experimental aortic and mitral regurgitation are also present in patients with chronic regurgitation. Additionally, observations that patients with mitral versus aortic regurgitation respond differently to valve replacement suggest that differences exist preoperatively between these two types of volume overload. Therefore, ventricular mechanics were compared in nine patients with severe aortic regurgitation, eight patients with severe mitral regurgitation and seven normal subjects. The amount of volume overload was similar in both groups with regurgitation. In both aortic and mitral regurgitation, ejection performance was reduced compared with findings in normal subjects. Preload estimated as enddiastolic stress was comparably elevated above normal in both groups with regurgitation: 69 +/- 24 dynes X 10(3)/cm2 in mitral regurgitation compared with 81 +/- 34 dynes X 10(3)/cm2 in aortic regurgitation and 36 +/- 11 dynes X 10(3)/cm2 in normal subjects. However, afterload estimated as mean systolic stress was normal in mitral regurgitation (186 +/- 34 dynes X 10(3)/cm2) but markedly elevated in aortic regurgitation (260 +/- 41 dynes X 10(3)/cm2) (p less than 0.01). Contractile depression tended to be more severe in mitral regurgitation despite similar ejection performance in mitral and aortic regurgitation. Thus, in mitral regurgitation favorable loading conditions may mask contractile dysfunction, and in aortic regurgitation excessive afterload contributes to poor pump performance, possibly accounting for previously observed differences in the response to valve replacement.
This article has been cited by other articles:
|
|
|
|
 
D. H. J. Elder, L. Wei, B. R. Szwejkowski, R. Libianto, A. Nadir, M. Pauriah, S. Rekhraj, T. K. Lim, J. George, A. Doney, et al.
The Impact of Renin-Angiotensin-Aldosterone System Blockade on Heart Failure Outcomes and Mortality in Patients Identified to Have Aortic Regurgitation: A Large Population Cohort Study
J. Am. Coll. Cardiol.,
November 8, 2011;
58(20):
2084 - 2091.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Sampat, P. Varadarajan, R. Turk, A. Kamath, S. Khandhar, and R. G. Pai
Effect of Beta-Blocker Therapy on Survival in Patients With Severe Aortic Regurgitation: Results From a Cohort of 756 Patients
J. Am. Coll. Cardiol.,
July 28, 2009;
54(5):
452 - 457.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. H. Gaasch and T. E. Meyer
Left Ventricular Response to Mitral Regurgitation: Implications for Management
Circulation,
November 25, 2008;
118(22):
2298 - 2303.
[Full Text]
[PDF]
|
|
|
|
|
|
|
2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
October 7, 2008;
118(15):
e523 - e661.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
September 23, 2008;
52(13):
e1 - e142.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. C. Nguyen, A. Itoh, C. J. Carlhall, W. Bothe, T. A. Timek, D. B. Ennis, R. A. Oakes, D. Liang, G. T. Daughters, N. B. Ingels Jr., et al.
The effect of pure mitral regurgitation on mitral annular geometry and three-dimensional saddle shape
J. Thorac. Cardiovasc. Surg.,
September 1, 2008;
136(3):
557 - 565.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Carabello
The Current Therapy for Mitral Regurgitation
J. Am. Coll. Cardiol.,
July 29, 2008;
52(5):
319 - 326.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena
Principles and Practice of Echocardiography in Cardiac Surgery
Card. Surg. Adult,
January 1, 2008;
3(2008):
315 - 348.
[Full Text]
|
|
|
|
|
|
|
T. Mihaljevic, M. R. Sayeed, S. C. Stamou, and S. Paul
Pathophysiology of Aortic Valve Disease
Card. Surg. Adult,
January 1, 2008;
3(2008):
825 - 840.
[Full Text]
|
|
|
|
|
|
|
F. Y. Chen and L. H. Cohn
Mitral Valve Repair
Card. Surg. Adult,
January 1, 2008;
3(2008):
1013 - 1030.
[Full Text]
|
|
|
|
|
|
|
S. H. Oh and D. G. Meyers
Afterload Reduction May Halt and Beta-Adrenergic Blockade May Worsen Progression of Left Ventricular Dysfunction in Patients With Chronic Compensated Mitral Regurgitation: A Retrospective Cohort Study
Angiology,
April 1, 2007;
58(2):
196 - 202.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
e1 - e148.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Maurer
Aortic regurgitation.
Heart,
July 1, 2006;
92(7):
994 - 1000.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Bekeredjian and P. A. Grayburn
Valvular Heart Disease: Aortic Regurgitation
Circulation,
July 5, 2005;
112(1):
125 - 134.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Byrne, D. M. Kaye, M. Mathis, D. G. Reuter, C. A. Alferness, and J. M. Power
Percutaneous Mitral Annular Reduction Provides Continued Benefit in an Ovine Model of Dilated Cardiomyopathy
Circulation,
November 9, 2004;
110(19):
3088 - 3092.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Carabello
Is it ever too late to operate on the patient with valvular heart disease?
J. Am. Coll. Cardiol.,
July 21, 2004;
44(2):
376 - 383.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Tarasoutchi, M. Grinberg, G. S. Spina, R. O. Sampaio, L. u. F. Cardoso, E. G. Rossi, P. Pomerantzeff, F. Laurindo, P. L. da Luz, and J. A. F. Ramires
Ten-year clinical laboratory follow-up after application of a symptom-based therapeutic strategy to patients with severe chronic aortic regurgitation of predominant rheumatic etiology
J. Am. Coll. Cardiol.,
April 16, 2003;
41(8):
1316 - 1324.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Mihaljevic, S. Paul, L. H. Cohn, and A. Wechsler
Pathophysiology of Aortic Valve Disease
Card. Surg. Adult,
January 1, 2003;
2(2003):
791 - 810.
[Full Text]
|
|
|
|
|
|
|
H. P. Chaliki, D. Mohty, J.-F. Avierinos, C. G. Scott, H. V. Schaff, A. J. Tajik, and M. Enriquez-Sarano
Outcomes After Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Markedly Reduced Left Ventricular Function
Circulation,
November 19, 2002;
106(21):
2687 - 2693.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. H. Gaasch and G. P. Aurigemma
Inhibition of therenin-angiotensin systemand the left ventricularadaptation to mitral regurgitation
J. Am. Coll. Cardiol.,
April 17, 2002;
39(8):
1380 - 1383.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. H. Devlin, J. Petrusha, K. Briesmiester, D. Montgomery, and M. R. Starling
Impact of Vascular Adaptation to Chronic Aortic Regurgitation on Left Ventricular Performance
Circulation,
March 2, 1999;
99(8):
1027 - 1033.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Umana, B. Salehizadeh, J. J. DeRose Jr, T. Nahar, A. Lotvin, S. Homma, and M. C. Oz
"Bow-Tie" mitral valve repair: An adjuvant technique for ischemic mitral regurgitation
Ann. Thorac. Surg.,
November 1, 1998;
66(5):
1640 - 1645.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Matsuo, B. A. Carabello, Y. Nagatomo, M. Koide, M. Hamawaki, M. R. Zile, and P. J. McDermott
Mechanisms of cardiac hypertrophy in canine volume overload
Am J Physiol Heart Circ Physiol,
July 1, 1998;
275(1):
H65 - H74.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Carabello
Aortic Regurgitation in Women: Does the Measuring Stick Need a Change?
Circulation,
November 15, 1996;
94(10):
2355 - 2357.
[Full Text]
|
|
|
|
|
|
|
B. A. Carabello
The changing unnatural history of valvular regurgitation
Ann. Thorac. Surg.,
February 1, 1992;
53(2):
191 - 199.
[Abstract]
[PDF]
|
|
|
|
