Q. Can my height and weight play a role in aortic regurgitation?

Answered by
Dr. Ritendra Nath Talapatra
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 19, 2017 and last reviewed on: Oct 09, 2018

Hello doctor,

I am 57 years old. I had a recent echocardiogram to monitor my moderate aortic regurgitation and mildly dilated aortic root and ascending aorta of 41 mm. Both remained stable.

My rest echo report indicated the following:

  • Normal left ventricular size.
  • Overall low normal systolic function with and EF of 54, LV FS equals 27%.
  • No resting regional wall abnormalities.
  • Spectral Doppler shows impaired relaxation pattern of LV diastolic filling and indeterminate LV filling pressure with E/A ratio equals 8.
  • Normal right ventricle size, wall thickness, and systolic function RVS equal 15 cm.
  • Mildly dilated left atrium of 23 cm2.
  • Normal right atrium.
  • Normal pericardium.
  • 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; PPG of 12mmHg; moderate aortic regurgitation 2-3/4; resting LVOT SV equals 125 mL Indexed equals 62 mL/m2
  • Mild regurgitation of mitral and tricuspid valves 1/4.
  • Normal pulmonary artery systolic pressure. RVSP equals 31 mmHg.

My questions are

  • My height, weight, and body surface area are 165 cm,96 kg, 2.03 m2. l am actually 182 cm 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 echo and does not think I will need a new valve in the short term. Does this seem reasonable?
  • I am 57 years old and am wondering if I should be worried about the reference to impaired relaxation pattern of LV diastolic filling.

I am currently on Atenolol 100 mg, Crestor 40 mg, and Effexor 75 mg. Please help.

#

Hello,

Welcome to icliniq.com.

I have evaluated your echo report.

In your case, the echo clearly shows that AR (atrial regurgitation) is due to a localized prolapse of the anterior half of RCC (right coronary cusp). So it is not due to coaptation failure.

By general rule, tallness has nothing to do with AR although there is a relation of large arm span (Marfan) associated with dilated aortic root producing AR.

According to the guidelines, aortic stenosis should be surgically managed if associated with LVEF (left ventricular ejection fraction) less than 40% and dilatation of left ventricle cavity.

Since you have only mild left ventricle dysfunction as of now, it is a wise choice to defer surgery.

Grade 1 diastolic dysfunction is normal with someone with moderate AR. I would suggest changing Atenolol to Metoprolol sustained release 50 mg twice a day.

For more information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist


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Thank you doctor,

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 follow standard guidelines by ACC and AHA (American College of Cardiology and the American Heart Association).

The guidelines clearly say that if a patient with LVEF (left ventricular ejection fraction) is greater than 50%, LVESD (left ventricular end-systolic dimension) is less than 5 and LVEDD (left ventricular end-diastolic dimension) is less than 6 then that patient can be followed up safely by medication.

Yes, LVEF (left ventricular ejection fraction) of 54% is mild or mid-range left ventricle function and it is declining because of AR (aortic regurgitation).

But with medications, surgery can be safely deferred for some time until your left ventricle function goes below 50 or LVEDD gets more than 6.

Eventually, you may need surgery when you fit for AVR (aortic valve replacement) according to guidelines.

For more information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist


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