Aortic Regurgitation: Contractility As Primary Prognosticator And Basis Of The Contractile Deficit

Earlier data indicate that, in asymptomatic patients with aortic regurgitation (AR) and normal left ventricular ejection fraction (LVEF) at rest, outcome (heart failure, subnormal LVEFrest, sudden death) is best predicted by intrinsic myocardial contractility, measured as change in end-systolic-wall-stress-adjusted LVEF from rest to exercise (DLVESS-DLVEF). Recent preliminary data, in patients studied shortly before aortic valve replacement (AVR) and followed for several years thereafter, supports the prognostic primacy of contractility. Contractile function is determined by the state of the cardiomyocyte, itself importantly affected by physical connections with the extracellular matrix (ECM). The ECM is disordered by direct molecular and cellular responses to the LV mechanical stresses of AR, now being elucidated.