ST Segment Depression on Exercise Testing in Chronic Aortic Regurgitation as a Criterion of Left Ventricular Dysfunction

Abstract

INTRODUCTION:
Angina pectoris is a classical symptom of aortic stenosis [AS) but may be associated with severe aortic regurgitation (AR). The cause of this with normal coronary arteries has been attributed to subendocardial ischaemia due to reduced supply and demand ratio. 1 This ratio is• rep resented by diastolic and systolic presure time indices (DPTI/SPTI). The possible mechanisms responsible for these ischaemic changes in the presence of normal coronary system, and the value of these changes with respect to timing of surgery are discussed.

DISCUSSION:

Angina in aortic valve disease occurs more commonly with stenosis than regurgitation. It is usually seen with severe AR and the reported incidence varies from 6 to 29%. Some of the atypical features of angina in AR include rest pains, prolonged episodes of pain, poor response to nitrates and occurrence of pain at slow heart rates especially during sleep. We have found that ST segment response to exercise as well as angiography may help as a marker to identify patients with exercise induced LV dysfunction. It requires a comprehensive study to establish this as a criterion for timing of surgery in asymptomatic and minimally symptomatic patients of severe AR. It will provide us a cheap, simple, and noninvasive tool for serial evaluation of such patients.