Prognostic value of left ventricular hypertrophy in postoperative outcomes in type A acute aortic dissection

Abstract

Background: Left ventricular hypertrophy (LVH) is common in hypertension patients. Hypertension is a recognized risk factor of acute aortic dissection. This study aimed to explore the prognostic value of LVH in predicting postoperative outcomes in type A acute aortic dissection (ATAAD) patients.Methods: This was a single-central retrospectively designed study. One hundred and ninety-three ATAAD patients who underwent surgical repair at Renmin Hospital of Wuhan University from January 2018 to November 2021 were enrolled. Patients were divided based on their left ventricular mass index (LVMI).We compared their baseline characteristics, perioperative data, and in-hospital outcome. Then nomogram models were developed based on logistic regression to predict the postoperative outcomes.Results: LVH presented in 28.5% (55 in 193) patients. LVH group had a higher proportion of female patients compared with the non-LVH group (32.7% vs. 17.4%, P=0.03). Decreased left ventricular ejection fraction and cardiac tamponade were more prevalent in patients with LVH. LVH group had a higher risk of postoperative composite major outcomes (CMO) and operative mortality. Based on multivariable logistic regression, LVH/LVMI, Penn classification, hyperlipidemia, emergency surgery and cardiopulmonary bypass duration were applied to develop nomogram models for predicting postoperative CMO. The area under curve was 0.825 (95% CI: 0.749-0.900) for Model LVH and 0.841 (95% CI: 0.776-0.905) for Model LVMI. Nomogram models for predicting postoperative cardiac were developed based on LVH/LVMI and cardiopulmonary bypass duration. The area under curves for the models involving LVH or LVMI were 0.782 (95% CI: 0.640-0.923) and 0.795 (95% CI: 0.643-0.947), respectively.Conclusions: LVH and increased LVMI was associated with increased risk of postoperative CMO and cardiac events in ATAAD patients. The nomogram models based on LVH or LVMI might help predict postoperative CMO. Future research would be necessary to investigate prognostic value of LVH for longterm outcomes in ATAAD patients.

Factors associated with in-hospital mortality and morbidity of patients with dissection of aorta type A, undergoing repair surgery

“…Additionally, left ventricular hypertrophy was identified as an important risk factor for postoperative complications and mortality. Zuo et al suggested that left ventricular hypertrophy is a risk factor for aortic enlargement and subsequent dissection [17].…”

The presence of left ventricular hypertrophy in patients with acute type A aortic dissection: weight on the postoperative clinical outcomes

“…The association between LVH and AD is surely an important issue to understand the physiology of AD. Given limitation from the retrospective observational study, however, inconvenience in the evaluation of the present study exists ( 9 ). First, too many factors were included in the multivariable risk analyses for only 38 of primary outcomes.…”

“…In the journal, Zuo and his colleagues reviewed 193 patients who underwent AD repair from 2018 to 2021 in their institute ( 9 ). Scope of the study was to evaluate impacts of left ventricular hypertrophy (LVH) on clinical outcomes (55 versus 138 patients with/without LVH).…”

Left ventricular hypertrophy in patients with acute type A aortic dissection: a formidable challenge

“…In their study titled “Prognostic value of left ventricular hypertrophy in postoperative outcomes in Type A acute aortic dissection”, Zuo and colleagues ( 5 ) from Wuhan, China analyzed the utility of LVH in predicting postoperative outcomes in patients with acute aortic Type A dissection (ATAAD). This was a retrospective, single-center analysis of 193 patients who underwent ATAAD surgical repair over a nearly four-year period.…”

“…The incidence of composite major outcomes (CMO), which included operative mortality, stroke, paraplegia, dialysis, and adverse cardiac events, was 30.9% in patients with LVH vs. 15.2% in patients without LVH. The LVH group had higher operative mortality (18.2% vs. 7.2%) and higher incidences of postoperative stroke, low cardiac output syndrome, and ventricular arrhythmias ( 5 ).…”