From the Guidelines
The patient's current condition, with a normal left ventricular systolic function and an ejection fraction of 62%, does not require immediate intervention for the mild calcification of the aortic valve and mild anterior mitral leaflet thickening, but regular monitoring with follow-up echocardiograms every 1-2 years is recommended. The findings of mild calcification of the aortic valve and mild thickening of the anterior mitral leaflet are consistent with early degenerative changes, which are relatively common, especially with aging 1. According to the 2020 ACC/AHA guideline for the management of patients with valvular heart disease, patients with mild valve abnormalities and normal left ventricular systolic function are classified as being at risk of aortic regurgitation (AR) or having progressive AR, but do not meet the criteria for severe AR or symptomatic severe AR 1.
Key Considerations
- The patient's left ventricular systolic function is normal, with an ejection fraction of 62%, which is within the healthy range.
- The mild calcification of the aortic valve and mild thickening of the anterior mitral leaflet are early degenerative changes that do not currently require specific treatment.
- Regular monitoring with follow-up echocardiograms every 1-2 years is recommended to track any progression of the valve abnormalities.
- Patients with these findings should maintain good cardiovascular health through regular exercise, blood pressure control, and a healthy diet.
- If symptoms such as shortness of breath, chest pain, or decreased exercise tolerance develop, earlier reassessment would be warranted.
Management and Monitoring
The management of patients with mild valve abnormalities and normal left ventricular systolic function focuses on monitoring and maintaining good cardiovascular health. As stated in the guideline, exercise testing is reasonable to confirm symptom status in patients with normal left ventricular systolic function 1. Regular follow-up echocardiograms will help track any progression of the valve disease, and earlier intervention can be considered if symptoms develop or if there is a significant decline in left ventricular systolic function.
From the Research
Left Ventricular Systolic Function
- The calculated ejection fraction is 62% by biplane method, which is considered normal 2.
- A normal left ventricular systolic function is typically defined as an ejection fraction of 50% or higher 3.
Aortic Valve Calcification
- There is mild calcification of the aortic valve, which may be an indicator of aortic stenosis (AS) 4, 5.
- Aortic stenosis can lead to left ventricular systolic dysfunction, even in patients with preserved ejection fraction 5.
Mitral Leaflet Thickening
- There is mild anterior mitral leaflet thickening, which may be a sign of mitral valve disease.
- However, the relationship between mitral leaflet thickening and left ventricular systolic function is not well established in the provided studies.
Prognostic Implications
- The presence of mild aortic valve calcification and preserved left ventricular systolic function may not necessarily indicate a poor prognosis 3.
- However, the development of left ventricular diastolic dysfunction can be a significant predictor of adverse outcomes, even in patients with moderate aortic stenosis and preserved systolic function 6.