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Editor's Note
November 4, 2020

Left Ventricular End-Systolic Volume in Chronic Aortic Regurgitation—Finally, a Step Forward

Author Affiliations
  • 1Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Editor, JAMA Cardiology
  • 3Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Deputy Editor, JAMA Cardiology
JAMA Cardiol. 2021;6(2):199. doi:10.1001/jamacardio.2020.5282

Left ventricular (LV) dilation and systolic function are important determinants of outcome in patients with chronic aortic regurgitation. Left ventricular end-systolic dimension (LVESD) is a particularly useful measure because it incorporates components of both systolic function and volume overload and has been associated with clinical outcomes in patients who are asymptomatic. Recommendations for aortic valve replacement (AVR) in patients without symptoms based on LVESD (and indexed LVESD [LVESDi]) thresholds have been imbedded in US and European guidelines since 1998. However, these recommendations stem from decades-old natural history studies conducted when only M-mode measurements were available. Linear measurements of LV dimensions provide imprecise estimates of LV volumes, given the variable effects of volume overload on LV shape. It is also unclear where in a remodeled LV the short-axis dimensions should be routinely measured.