The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed the structural and functional effects of severe AR on LV and left atrium before and after aortic valve replacement. Patients with severe AR scheduled for aortic valve replacement (n = 65) underwent two- and three-dimensional echocardiography, including left atrial strain imaging, before and 1 year after surgery. A control group was selected, and comprised patients undergoing surgery for thoracic aortic aneurysm without aortic valve replacement (n = 20). Logistic regression analysis was used to assess predictors of impaired left ventricular functional and structural recovery, defined as a composite variable of diastolic dysfunction grade ≥ 2, EF < 50%, or left ventricular end-diastolic volume index above the gender-specific normal range. Diastolic dysfunction was present in 32% of patients with AR at baseline. Diastolic LV function indices and left atrial strain improved, and both left atrial and LV volumes decreased in the AR group following aortic valve replacement. Preoperative left atrial strain during the conduit phase added to left ventricular end-systolic volume index for the prediction of impaired LV functional and structural recovery after aortic valve replacement (model p < 0.001, accuracy 70%; addition of left atrial strain during the conduit phase to end-systolic volume index p = 0.006). One-third of patients with severe AR had signs of diastolic dysfunction. Aortic valve surgery reduced LV and left atrial volumes and improved diastolic indices. Left atrial strain during the conduit phase added to the well-established left ventricular end-diastolic dimension for the prediction of impaired left ventricular functional and structural recovery at follow-up. However, long-term follow-up studies with hard endpoints are needed to assess the value of left atrial strain as predictor of myocardial recovery in aortic regurgitation.

中文翻译：

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严重主动脉瓣关闭不全的术前和术后左心房和心室容积和变形分析

主动脉瓣关闭不全 (AR) 引起的容量超负荷对收缩和舒张左心室 (LV) 指数和左心房重构的影响尚不清楚。我们评估了主动脉瓣置换前后严重 AR 对 LV 和左心房的结构和功能影响。计划进行主动脉瓣置换术的重度 AR 患者（n = 65）在手术前和手术后 1 年接受了二维和三维超声心动图检查，包括左心房应变成像。选择了一个对照组，其中包括接受胸主动脉瘤手术而未进行主动脉瓣置换术的患者（n = 20）。Logistic 回归分析用于评估左心室功能和结构恢复受损的预测因素，定义为舒张功能障碍 ≥ 2 级、EF < 50%、或左心室舒张末期容积指数高于性别特定的正常范围。32% 的基线 AR 患者存在舒张功能障碍。主动脉瓣置换术后，AR 组舒张期 LV 功能指数和左心房应变得到改善，左心房和 LV 容积均减少。将导管期术前左心房应变添加到左心室收缩末期容积指数，以预测主动脉瓣置换术后受损的 LV 功能和结构恢复（模型 p < 0.001，准确度 70%；导管期左心房应变的增加收缩末期容积指数 p = 0.006）。三分之一的严重 AR 患者有舒张功能障碍的迹象。主动脉瓣手术减少了 LV 和左心房容积并改善了舒张指数。导管相期间的左心房应变添加到完善的左心室舒张末期维度，用于预测随访时受损的左心室功能和结构恢复。然而，需要具有硬终点的长期随访研究来评估左心房应变作为主动脉瓣关闭不全中心肌恢复预测因子的价值。