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Little difference in gene and protein expression and substrate utilization were seen when comparing no intervention with strain modeling the normal LV [14]. , table 1, indicating result of AR strain versus no strain). Though some quantitative differences were apparent, the contrast between unstrained and AR-strained cardiac fibroblasts paralleled those found in comparing cardiac fibroblasts from normal hearts to cardiac fibroblasts from hearts with AR. These findings strongly suggest that ECM remodeling in AR is a primary response to the mechanical stresses of volume loading.

Measurement of ⌬LVEF is less cumbersome than contractility assessment and, together with LVIDs, represents a powerful additional prognosticator that can be usefully applied in patients with normal LVEFrest. Change Rates of Risk Descriptors Intuitively, prognosis also should be inferable from the deterioration rate of systolic phase descriptors even if, nominally, these descriptors remain within normal range. Data support this inference. Several parameters have demonstrated predictive value when used to segregate populations for risk assessment [10, 13, 23].

6] studied LV ejection performance and myocardial contractility prior to the surgical creation of MR, 3 months after the surgical creation of MR, and 1 and 3 months after mitral valve surgery to eliminate MR. They observed that in comparison to the presurgical assessment, LV ejection fraction was unchanged with creation of MR and diminished slightly after mitral valve surgery. This was not true for myocardial contractility. In comparison to the pre-operative LV elastance and stiffness calculations, 3 months after surgical creation of MR, LV contractility was significantly impaired.

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