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Aortic regurgitation: why can EF be misleading? In severe aortic regurgitation, the LV ejects blood in two directions: forward into the aorta and backward into the LV. That changes how we interpret stroke volume and EF. ⬜ Acute severe AR: Total stroke volume rises, but forward stroke volume falls. LVEDP rises sharply. 🟧 Chronic compensated AR: LV dilates and develops eccentric hypertrophy. EDV increases, allowing both total and forward stroke volume to rise while filling pressure remains relatively normal. 🟩 Chronic decompensated AR: LV contractile function deteriorates. ESV rises, EF falls, forward stroke volume falls, and LV filling pressure rises again. 🟥 After valve replacement: EF may initially fall because the low-resistance regurgitant pathway has been eliminated. This does not necessarily mean the LV has worsened. Forward stroke volume improves, and EF can recover with remodeling. Key point: In severe AR, a normal or high EF does not necessarily mean normal LV function. The LV is ejecting blood both forward and back into the ventricle. #Cardiology