A method for the measurement of left ventricular overload for aortic valve insufficiency

BackgroundThe degree of left ventricular overload in patients with aortic valve insufficiency (AI) plays an important role in determining the need and timing of surgical intervention. Because hemodynamic evaluation of AI may potentially predict the effects of an insufficient valve on the ventricle before they occur, it would be useful to guide valve surgery with such a diagnostic tool. The purpose of this study was to test the performance of a new hemodynamic index based on mechanical energy loss for the measurement of the effects of insufficiency on ventricular workload.Methods and resultsAn intact and subsequently perforated aortic bioprosthesis was tested within an in vitro model of the left heart, varying cardiac output, diastolic aortic pressure, and the size of perforation. Regurgitant orifice area (ROA), regurgitant volume (RV), regurgitant fraction (RF), and energy loss index (ELI) were measured for each experimental condition and plotted against the increase in workload per unit volume net forward flow (ΔWPV) due to perforation. ROA, RV, and RF showed good correlations with ΔWPV, but the relationship between these variables and ΔWPV became ambiguous as their magnitudes increased. ELI had a near perfect linear relationship with ΔWPV (slope=1.00, r2=0.98) independent of the experimental condition.ConclusionsRV, RF, and ROA do not by themselves fully describe the increase in difficulty the ventricle has in moving the blood across an insufficient valve. ELI, in contrast, was found to be a very good measure of the decrease in pump efficiency due to aortic valve insufficiency.