Serial Echocardiographic Evaluation of Left Ventricular Function in Valvular Disease, Including Reproducibility Guidelines for Serial Studies

Longitudinal echocardiographic studies of left ventricular (LV) function in valvular disease were evaluated in 24 medically treated patients followed for 6 months to 3 years (mean 16.3 months) and in 22 surgically treated patients before and at least 1 year after operation (mean 14 months). In initial reproducibility studies of enlarged hearts (mean end-diastolic dimension [EDDI 6.6 0.2 cm [± SEM], range 4.8–8.8 cm), serial changes in LVEDD exceeding ± 0.3 cm and in the percentage of minor diameter systolic shortening (%D) greater than ± 5.5% were considered biologically significant (outside the range of measurement and temporal variability). Guidelines for serial echocardiographic tracking of the left ventricle are presented. Medically treated patients were divided into three categories according to EDD and %D: (1) stable or improved LV size and function (seven patients); (2) progressive LV dilatation with stable function (seven patients), in which EDD increased by 0.5–1.2 cm (mean EDD 5.8 ± 0.4 to 6.6 i 0.4 cm, p < 0.001), with no significant change in %D; and (3) LV decompensation (10 patients), with %D declining by 6–20% (mean %D 38 ± 2.0% to 28 ± 1.8%, p < 0.001), usually associated with an increasing EDD (mean EDD 6.0 + 0.3 to 6.7 ± 0.3 cm, p < 0.001). In 15 surgical patients EDD decreased postoperatively by 0.4–2.2 cm (mean EDD 6.3 ± 0.2 to 5.2 ± 0.2 cm, p < 0.001), while seven patients had either no postoperative change or an increase in EDD of 0.4–1.0 cm (mean EDD 7.0 ± 0.5 to 7.2 i 0.6 cm). In 17 of 24 medical (70%) and 17 of 22 surgical patients (77%), the results of serial echocardiographic assessment of the EDD and %D were in agreement with the results of other noninvasive methods of evaluating the left ventricle. Echocardiographic evidence of progressive LV dysfunction was otherwise clinically silent in six medical patients. The preoperative findings of an EDD greater than 8.0 cm, ESD greater than or equal to 6.4 cm and low %D (. 22%) were noted only in three patients with aortic insufficiency who had postoperative heart failure probably secondary to irreversible myocardial damage sustained before surgery.Thus, echocardiography is valuable in longitudinal pre- and postoperative evaluation of LV function in patients with valvular disease, and may aid in recognition of early, otherwise undetected, or irreversible LV dilatation and dysfunction.