Q. Systolic dysfunction onset of symptoms?
In asymptomatic patients with normal LV function, the rate of progression to symptoms and/or LV Systolic dysfunction is about 4 per cent per year. Average mortality rate is 0.2 per cent per year. 1.3 per cent patients per year developed LV Systolic dysfunction without symptoms. Systolic dysfunction precedes onset of symptoms about 25 per cent of patients. Serial follow up based only on symptom status evaluation is not reliable and quantitative evaluation of left ventricle is needed. Age, end systolic dimension or volume, end diastolic volume or dimensions are good indicators of onset of LV dysfunction, symptoms and/or death. Patients with end systolic dimension of > 50 mm have a likelihood of death, symptom onset and/or LV dysfunction of about 20 per cent year. In those with end systolic dimension between 40-50 mm the likelihood is about 6 per cent per year and in those with less than 40 mm it is zero. Patients with asymptomatic LV
systolic dysfunction develop symptoms within 2-3 years at a rate of about 25 per cent per year. In the presurgical era, data has shown annual mortality rate of > 10 per cent in patient with angina and > 20 per cent in patients with heart failure. Symptomatic patient have poorer prognosis even when they have preserved LV function while mild AR in an elderly hypertensive may not need any serious follow up. Same is not true in an young patient with mild AR due to bicuspid aortic valve or aortic root dilatation.