Patient's Query
Hello doctor,
I am 57 years old. I recently had an echocardiogram to monitor my moderate aortic regurgitation and mildly dilated aortic root and ascending aorta, which measures 41 mm. Both conditions remained stable. My resting echocardiogram report indicated the following findings: normal left ventricular size, overall low-normal systolic function with an ejection fraction (EF) of 54 percent, left ventricular fractional shortening (LV FS) of 27 percent, no resting regional wall abnormalities, and a spectral Doppler showing an impaired relaxation pattern of left ventricular diastolic filling with indeterminate left ventricular filling pressure, indicated by an E/A ratio of 0.8. The right ventricle size, wall thickness, and systolic function are normal, with a right ventricular size (RVS) of 15 cm. There is a mildly dilated left atrium measuring 23 cm², a normal right atrium, a normal pericardium, and a tricuspid aortic valve with localized prolapse of the anterior half of the right coronary cusp, resulting in eccentric, posterolaterally directed aortic regurgitation with no evidence of stenosis. The peak gradient pressure (PPG) is 12 mmHg, and the aortic regurgitation is classified as moderate (2-3/4). The resting left ventricular outflow tract stroke volume (LVOT SV) is 125 mL, indexed to 62 mL/m². There is mild regurgitation of the mitral and tricuspid valves (1/4), and the pulmonary artery systolic pressure is normal, with a right ventricular systolic pressure (RVSP) of 31 mmHg.
My questions are as follows: My height, weight, and body surface area are 5'4", 211 pounds, and 2.03 m². I am actually 5'9" tall and was wondering if this affects the measurements in any way. My cardiologist wants to see me in a year for a follow-up echocardiogram and does not think I will need a new valve in the short term. Does this seem reasonable? I am concerned about the reference to the impaired relaxation pattern of left ventricular diastolic filling. I am currently taking Atenolol 100 mg, Rosuvastatin 40 mg, and Venlafaxine 75 mg.
Please help.
Hello,
Welcome to icliniq.com.
I have evaluated your echocardiography report. In your case, the echocardiogram clearly shows that the aortic regurgitation (AR) is due to a localized prolapse of the anterior half of the right coronary cusp (RCC) and is not due to coaptation failure. As a general rule, height has no direct relation to AR; however, there is an association between a large arm span (as seen in Marfan syndrome) and a dilated aortic root, which can lead to AR. According to the guidelines, aortic stenosis should be surgically managed if it is associated with a left ventricular ejection fraction (LVEF) of less than 40 percent and dilation of the left ventricular cavity. Since you currently have only mild left ventricular dysfunction, it is wise to defer surgery. Grade 1 diastolic dysfunction is considered normal for someone with moderate AR.
I would suggest changing Atenolol to Metoprolol sustained release at a dosage of 50 mg twice a day. Consult your specialist doctor, discuss with him or her, and take the medicines with take the medicines with their consent.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
Is ejection fraction of 54 normal? There is so much information on the internet saying that 55 is the threshold marker for normal. This worries me a little.
Hello,
Welcome back to icliniq.com.
We doctors adhere to standard guidelines set by the American College of Cardiology (ACC) and the American Heart Association (AHA). The guidelines clearly state that if a patient has a left ventricular ejection fraction (LVEF) greater than 50 percent, a left ventricular end-systolic dimension (LVESD) of less than 5 cm, and a left ventricular end-diastolic dimension (LVEDD) of less than 6 cm, then that patient can be safely monitored with medication.
Yes, an LVEF of 54 percent indicates mild to mid-range left ventricular function, which is declining due to aortic regurgitation (AR). However, with appropriate medications, surgery can be safely deferred until your left ventricular function drops below 50 percent or the LVEDD exceeds 6 cm. Eventually, you may need surgery when you meet the criteria for aortic valve replacement (AVR) according to the guidelines.
I hope this helps you.
Thank you.
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