Long Term Results and Predictors of Left Ventricular Function Recovery after Aortic Valve Replacement for Chronic Aortic Regurgitation

Saisho, Hiroyuki; Arinaga, Koichi; Kikusaki, Satoshi; Hirata, Yoshihiro; Wada, Kumiko; Kakuma, Tatsuyuki; Tanaka, Hiroyuki

doi:10.5761/atcs.oa.14-00295

Cited by 23 publications

(13 citation statements)

References 32 publications

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“…Furthermore, in this study, preoperative lower LVEF was detected as the most powerful predictor for postoperative LV systolic dysfunction. Hiroyuki saisho et al 23 also revealed that, depressed preoperative LVEF (<50.2%) with increased LVESDI (≥26.7 mm/m 2 ), and decreased cardiac index (<2.71 L/min/m 2 ) were associated with poor LV systolic function after AVR 23 . On the contrary, in a study by Bonow et al 20 postoperative LVEF was not associated with preoperative LVEF in patients with severe AR and LV systolic dysfunction.…”

Section: Discussionmentioning

confidence: 95%

Presence of fragmented QRS is associated with left ventricular systolic dysfunction after surgery in patients with severe aortic regurgitation

et al. 2021

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Background and Aim of the study: Chronic severe aortic regurgitation (AR) is associated with progressive accumulation of interstitial fibrosis and disruption of myocardial structure. After aortic valve replacement (AVR), the negative remodeling process reverses, and left ventricular ejection fraction (LVEF) improves but not in all patients. In this study, we aimed to investigate the association of fragmented QRS (F-QRS), which is a possible marker of myocardial fibrosis, with postoperative left ventricular (LV) systolic dysfunction. Methods: A total of 147 consecutive patients with AVR were included in this study. F-QRS was identified by the presence of various RSR' patterns (QRS duration <120 ms) such as additional R wave (R prime)or notching of the R or S wave in at least two consecutive leads. Patients were compared in two groups based on the presence or absence of F-QRS. A logistic regression model was used to determine independent predictors of postoperative LV systolic dysfunction (LVEF <50%). Results: Patients with F-QRS were associated with poor recovery of LV systolic function after AVR compared to the patients without F-QRS, regardless of preoperative LVEF (p = .008). F-QRS was found to be an independent predictor of postoperative LV systolic dysfunction (LVEF <50%). Lower preoperative LVEF and increased LV end diastolic diameter index were also found as independent risk factors for postoperative LV systolic dysfunction. Conclusions: As a possible marker of myocardial fibrosis, F-QRS was associated with postoperative LV systolic dysfunction. Therefore, as a simple and convenient clinical parameter, F-QRS may be used to predict poor recovery of LVEF after AVR.

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Section: Discussionmentioning

confidence: 95%

Presence of fragmented QRS is associated with left ventricular systolic dysfunction after surgery in patients with severe aortic regurgitation

et al. 2021

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“…In contrast, the post-operative LV mass regression process in patients with AR is less extensively studied. Studies performing sequential measurements of LV dimensions showed a steep decline of indexed LV diameters in the early post-operative period and at 1- to 2-year follow-up with stabilization of this reduction thereafter 22 , 27 …”

Section: Discussionmentioning

confidence: 99%

Time course of left ventricular remodelling and mechanics after aortic valve surgery: aortic stenosis vs. aortic regurgitation

Vollema

Singh

Prihadi

et al. 2019

European Heart Journal - Cardiovascular Imaging

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Aims Pressure overload in aortic stenosis (AS) and both pressure and volume overload in aortic regurgitation (AR) induce concentric and eccentric hypertrophy, respectively. These structural changes influence left ventricular (LV) mechanics, but little is known about the time course of LV remodelling and mechanics after aortic valve surgery (AVR) and its differences in AS vs. AR. The present study aimed to characterize the time course of LV mass index (LVMI) and LV mechanics [by LV global longitudinal strain (LV GLS)] after AVR in AS vs. AR. Methods and results Two hundred and eleven (61 ± 14 years, 61% male) patients with severe AS (63%) or AR (37%) undergoing surgical AVR with routine echocardiographic follow-up at 1, 2, and/or 5 years were evaluated. Before AVR, LVMI was larger in AR patients compared with AS. Both groups showed moderately impaired LV GLS, but preserved LV ejection fraction. After surgery, both groups showed LV mass regression, although a more pronounced decline was seen in AR patients. Improvement in LV GLS was observed in both groups, but characterized by an initial decline in AR patients while LV GLS in AS patients remained initially stable. Conclusion In severe AS and AR patients undergoing AVR, LV mass regression and changes in LV GLS are similar despite different LV remodelling before AVR. In AR, relief of volume overload led to reduction in LVMI and an initial decline in LV GLS. In contrast, relief of pressure overload in AS was characterized by a stable LV GLS and more sustained LV mass regression.

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“…Volume overload and pressure overload occur simultaneously in patients of chronic severe AR so LVEF and LVESD are used to measure to pumping strength of LV and LVEDD are used for the measurement of severity of volume overload 16. After AVR, LVEDD are usually reduced within a few days after operation, resulting in reduction in preload and a transient decrease of LVEF 14,17.…”

Section: Discussionmentioning

confidence: 99%

Frequency of early remodeling of left ventricle and its comparison between patients with stroke volume >97 Ml versus patients with stroke volume <97 Ml after aortic valve replacement for severe aortic regurgitation

Rizvi¹,

Khalid²,

Baksh³

et al. 2016

Pak J Med Sci

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Objectives:To evaluate the frequency of early remodeling in patients of severe aortic regurgitation after aortic valve replacement and to see the incidence of early remodeling in patients with stroke volume >97 ml versus < 97 ml before aortic valve replacement.Method:This was a prospective comparative study conducted from August 2013 to December 2014 in a tertiary care hospital. Fifty seven (57) patients of isolated chronic aortic regurgitation were included in this study. SPSS v23 was used for data analysis. Independent sample t-test was used for analysis of continuous variables and chi-square test for qualitative variables.Results:Out of fifty seven patients, early remodeling occurred in 34 (59.64%) patients after surgery. The mean pre-operative stroke volume of patient in whom remodeling occurred was 110.3+9.66 ml while mean pre-operative stroke volume of patients who did not undergo remodeling was 86.65+7.63 ml. There were 28 (82.4%) patients with stroke volume >97 ml in whom Remodeling occurred where as in patients with stroke volume <97 ml remodeling occurred only in 6 (17.6%) patients (p value 0.004). There was no in-hospital mortality.Conclusion:There is an association between stroke volume and early LV remodeling after Aortic valve replacement. Stroke volume >97 ml is a good predictor of early LV remodeling.

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Long Term Results and Predictors of Left Ventricular Function Recovery after Aortic Valve Replacement for Chronic Aortic Regurgitation

Cited by 23 publications

References 32 publications

Presence of fragmented QRS is associated with left ventricular systolic dysfunction after surgery in patients with severe aortic regurgitation

Presence of fragmented QRS is associated with left ventricular systolic dysfunction after surgery in patients with severe aortic regurgitation

Time course of left ventricular remodelling and mechanics after aortic valve surgery: aortic stenosis vs. aortic regurgitation

Frequency of early remodeling of left ventricle and its comparison between patients with stroke volume >97 Ml versus patients with stroke volume <97 Ml after aortic valve replacement for severe aortic regurgitation

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