Author + information
- Received May 9, 2011
- Revision received November 22, 2011
- Accepted December 14, 2011
- Published online June 1, 2012.
- Thomas L. Gentles, FRACP⁎,⁎ (, )
- John K. French, MB, PhD†,‡,
- Irene Zeng, MSc†,
- Paget F. Milsom, FRACS§,
- A. Kirsten Finucane, FRACS⁎ and
- Nigel J. Wilson, FRACP⁎
- ↵⁎Reprint requests and correspondence:
Dr. Tom Gentles, Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Private Bag 92 024, Auckland 1142, New Zealand
Pre-operative end-systolic volume (ESV) is predictive of outcome after surgery for severe aortic regurgitation. ESV is influenced by body size and reflects function and afterload, but not pre-load. Left ventricular (LV) chamber size and function were measured in 40 patients (ages 10 to 64 years) by echocardiography before and 7 months after operation and expressed as z-scores in addition to simple indexing. A functional pre-load index, a marker of pre-load reserve, was calculated. Independent risk factors for post-operative LV dysfunction included higher post-operative ESV z-score (odds ratio [OR]: 3.3, p = 0.006) and lower functional pre-load index (OR: 0.3, p = 0.03). ESV per square meter had similar power to the ESV z-score. The ESV uncorrected for body size underestimated risk in smaller patients and overestimated risk in larger patients (p < 0.002). Pre-load reserve is an independent risk factor for LV dysfunction after aortic valve surgery in patients with severe aortic regurgitation. Failure to correct ESV for body size introduces systematic bias to risk assessment.
This work was supported by a Project Grant from the National Heart Foundation of New Zealand, and salary (to Dr. Zeng) and secretarial support from the Green Lane Research and Education Fund. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Zeng currently works at the Center of Clinical Research and Effective Practice, Middlemore Hospital, Auckland, New Zealand.
- Received May 9, 2011.
- Revision received November 22, 2011.
- Accepted December 14, 2011.
- American College of Cardiology Foundation