Association of left ventricular volume in predicting clinical outcomes in patients with aortic regurgitation.

ABSTRACT Background Aortic regurgitation (AR) is a common valvular lesion associated with increased mortality once the left ventricle (LV) enlarges significantly or develops systolic dysfunction (EF Methods We retrospectively analyzed 1100 consecutive patients with chronic moderate-severe and severe AR by echocardiography between 2004 and 2019. Modified Simpson’s disc summation method was used for LV volume estimation. The primary outcome was all-cause mortality; secondary outcome was mortality censored at AVR. Results Patients’ age was 60 ± 17 years and 198 (18%) were women. Volumes were measured by biplane method in 939 (85%) patients and monoplane in 161 (15%); end-systolic volume was normal in 169 (11%). Correlations between volumes and linear dimensions were 0.5 for end-diastolic and 0.6 for end-systolic. At median follow up of 5.4 (2.4-10.0) years, 216 patients died and 539 underwent AVR. Indexed LV end-systolic volume (iLVESV) and iLVESD were both associated with mortality and symptoms, but association of iLVESV was stronger. iLVESV, age, male gender, Charlson comorbidity index, NYHA class III-IV, and time dependent AVR were independently associated with all-cause mortality. The inter-observer variability in estimation of LV volumes in 200 patients included intra-class coefficient 0.94 (0.92-0.95) for end-diastolic and 0.88 (0.78-0.93) for end-systolic volume. Patients with iLVESV≥45ml/m2 had lower survival and higher prevalence of symptoms than those with volumes Conclusion Echocardiographic LV volume assessment had good reproducibility in patients with moderate-severe and severe AR. The correlation between linear dimensions and volumes was limited. Both iLVESV and iLVESD were associated with worse outcomes, but association of iLVESV was stronger. iLVESV ≥45ml/m2 was associated with worse outcomes.