This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tarasoutchi, F. Articles by Ramires, J. A. F. Search for Related Content PubMed PubMed Citation Articles by Tarasoutchi, F. Articles by Ramires, J. A. F.

CLINICAL STUDY: VALVULAR HEART DISEASE

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

^* Instituto do Coração, (InCor), University of São Paulo School of Medicine, Valvular Hear Disease Unit, São Paulo, Brazil

Manuscript received May 2, 2002; revised manuscript received October 21, 2002, accepted November 19, 2002.

^* Reprint requests and correspondence: Dr. Flavio Tarasoutchi, Instituto do Coração, (InCor), University of São Paulo School of Medicine, Valvular Heart Disease Unit, Av. Enéas de C. Aguiar, 44, São Paulo, SP 05403-000, Brazil.
tarasout{at}uol.com.br

OBJECTIVES: This study was designed to assess the feasibility and the long-term results of a symptom-based strategy of aortic valve replacement in a Brazilian population with predominant rheumatic etiology.

BACKGROUND: Optimal criteria for valve replacement in aortic regurgitation (AR) are still not entirely clear. The appearance of symptoms is an indication for surgery, but may be associated with myocardial damage. Although cardiac imaging data have provided a safer guide for such decisions, the use of symptom-based surgical indication has not been validated and might conceivably be better in populations with predominant rheumatic etiology and younger age.

METHODS: Echocardiography and rest-exercise radionuclide ventriculography were performed in 75 patients with severe AR, age 28 ± 9 years, over a period of 10 ± 0.69 years. Thirty-seven patients developed symptoms and underwent aortic valve replacement surgery within six months. Thirty-eight patients remained asymptomatic and were managed medically.

RESULTS: Survival was 100% in asymptomatic patients and 82% in symptomatic. Surgical treatment caused marked ventricular remodeling, with ventricular diameter involution and an improvement of rest-exercise ejection fraction percent variation. Multivariate analysis showed that the probability of developing symptoms within 10 years was 58% for a patient with a left ventricular end-diastolic diameter 70 mm and 76% for a patient with left ventricular end-systolic (LVESD) 50 mm. Logistic regression identified LVESD and age as the most predictive and specific, but not sensitive, indicators of symptom development.

CONCLUSIONS: Application of a standardized therapeutic strategy to patients with severe AR and predominant rheumatic etiology resulted in 90.6% survival after 10 years of follow-up.

Abbreviations and Acronyms   ACC   American College of Cardiology   AHA   American Heart Association   AR   aortic regurgitation   EF r-ex   rest-exercise variation in left ventricular ejection fraction   FC   functional class   LV   left ventricular   LVEDD   left ventricular end-diastolic diameter   LVEF   left ventricular ejection fraction   LVESD   left ventricular end-systolic diameter   SF   shortening fraction

This article has been cited by other articles:

				M. L. Brown, H. V. Schaff, R. M. Suri, L. Zhuo, T. M. Sundt, J. A. Dearani, R. C. Daly, and T. A. Orszulak Indexed Left Ventricular Dimensions Best Predict Survival After Aortic Valve Replacement in Patients With Aortic Valve Regurgitation Ann. Thorac. Surg., April 1, 2009; 87(4): 1170 - 1176. [Abstract] [Full Text] [PDF]

				D. Detaint, J. Maalouf, C. Tribouilloy, D. W. Mahoney, H. V. Schaff, A. J. Tajik, and M. Enriquez-Sarano Congestive heart failure complicating aortic regurgitation with medical and surgical management: a prospective study of traditional and quantitative echocardiographic markers. J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1549 - 1557. [Abstract] [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]

				D. Detaint, D. Messika-Zeitoun, J. Maalouf, C. Tribouilloy, D. W. Mahoney, A. J. Tajik, and M. Enriquez-Sarano Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study. J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 1 - 11. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]

				J. R. Wollmuth, D. R. Bree, B. P. Cupps, M. D. Krock, B. J. Pomerantz, R. P. Pasque, A. Howells, N. Moazami, N. T. Kouchoukos, and M. K. Pasque Left ventricular wall stress in patients with severe aortic insufficiency with finite element analysis. Ann. Thorac. Surg., September 1, 2006; 82(3): 840 - 846. [Abstract] [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. 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]

				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 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: 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): 598 - 675. [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. Enriquez-Sarano and A. J. Tajik Aortic Regurgitation N. Engl. J. Med., October 7, 2004; 351(15): 1539 - 1546. [Full Text] [PDF]

				S. H. Rahimtoola The year in valvular heart disease J. Am. Coll. Cardiol., February 4, 2004; 43(3): 491 - 504. [Full Text] [PDF]

				J. S. Borer and R. O. Bonow Contemporary Approach to Aortic and Mitral Regurgitation Circulation, November 18, 2003; 108(20): 2432 - 2438. [Full Text] [PDF]

				W. H. Gaasch and E. C. Schick Symptoms and left ventricular size and function in patients with chronic aortic regurgitation J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1325 - 1328. [Full Text] [PDF]