Left ventricular remodeling after valve replacement in patients with isolated aortic regurgitation.

Replacement in Patients With Isolated Aortic Regurgitation To the Editor: We read with great interest a paper by Chaliki and associates in the November 19, 2002, issue of Circulation.1 In their study, patients with markedly impaired left ventricular (LV) function were compared with those with moderately impaired or normal LV function. Operative mortality was higher among the markedly impaired LV patients, their 10-year survival rate being lower than that of the other patients. Median time from surgery to postoperative echocardiography was 11.3 months, and ejection fraction of the left ventricle improved significantly in patients with preoperatively impaired LV function. However, improvement was limited to below normal levels, whereas the other patients regained or maintained almost normal levels. Although we agree with the results of Chaliki et al with regard to long-term survival, we have some comments about their evaluation of LV function after operation. We previously reported a follow-up study involving 25 consecutive patients with isolated aortic valve regurgitation, in which we compared patients with markedly impaired LV function with others according to preoperative echocardiographic findings.2 Considering LV end-systolic dimension (LVDs) and fractional shortening (FS), 13 patients with both LVDs 50 mm and FS 25% were classified as Group I, and the others were classified as Group II. Echocardiography was serially performed at 1, 3, and 5 years after the operation. Group 1 had regained normal LV function by 3 years after the operation and maintained it thereafter, whereas Group 2 had regained normal function by 1 year and maintained it through 5 years after operation. In the study of Chaliki and associates, echocardiography was performed just 11.3 months after operation. Henry et al3 showed that the decrease in LV size among patients with LVDs 55 mm and FS 25% had occurred by the time of the early period of the study (8 to 22 days postoperatively), with little additional change thereafter for up to 6 months in patients undergoing aortic valve replacement for isolated aortic regurgitation. However, Fioretti et al4 showed that echocardiograms at least 1 year after aortic valve replacement among patients with impaired LV function revealed LVDs decreased to levels similar to those found among the other patients. Japanese people have smaller body dimensions than people of Anglo-Saxon or Germanic descent and other similar groups; these physical differences led us to choose LVDs 50 mm as a factor for impaired LV function. Different follow-up periods may lead to different clinical results. Therefore, conclusive evaluations of follow-up studies such as LV function need to be based on serial assessments.