• aortic regurgitation
• diastolic overload
• echocardiography
• valvular heart disease

Background: Left ventricle (LV) dilatation and diastolic overload might be an early sign of severe aortic regurgitation (AR). Transthoracic echocardiography (TTE) is sensible and specific to evaluate LV function and volumes. However, it may inaccurately assess the severity of AR. We sought to develop a new echocardiographic method to detect early LV overload in patients with AR.
Methods: We retrospectively analyzed TTE datasets of patients with any grade of isolated AR. Patients were divided into three groups based on the severity of AR: mild, moderate, and severe. In addition to conventional measurements, we sought the presence of the diastolic recoil sign (DRS). Using the M-mode parasternal long-axis view, DRS is defined as early diastolic biphasic motion of the interventricular septum or posterior wall, which occurs following the normal LV filling phase and is caused by the pathological AR volume. The impact of pre-operative DRS on post-operative LV ejection fraction (LVEF) was assessed in patients with severe AR who underwent surgery.
Results: We included 94 patients with AR (34 with mild, 30 with moderate, and 30 with severe AR). Populations were comparable for demographic characteristics. LVEF was preserved in all groups with no significant difference in the 3 populations, while indexed LV end-diastolic volume (LVEDVi) proportionally increased with the severity of AR (73 ± 26 mL/m2 in mild-AR, 79,4 ± 32,6 mL/m2 in moderate-AR, and 108,5 ± 28,9 mL/m2 in severe-AR, p=0.002). The DRS was present in 76% cases in the severe-AR group, 13% in the moderate group, and 5% in the mild group (p<0.001). The ROC curve showed that the DRS is specific and sensitive to identify diastolic overload with a cut-off value of 86,7 mL/m2, (AUC 0,811). After adjustments, DRS tended to predict a lower post-operative LVEF, but with no statistical significance (β=4.61, p=0.175).
Conclusions: The presence of DRS is a sign of hemodynamically relevant AR and patients who present DRS might develop post-operative LV dysfunction once they undergo surgery. However, further analyses with larger sample size and combining different imaging techniques are necessary to confirm these early findings.