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

Vollema, E. Mara; Singh, Gurpreet K; Prihadi, Edgard A.; Regeer, Madelien V.; Ewe, See Hooi; Ng, Arnold C.T.; Mertens, Bart; Klautz, Robert J.M.; Marsan, Nina Ajmone; Bax, Jeroen J.; Delgado, Victoria

doi:10.1093/ehjci/jez049

Cited by 30 publications

(18 citation statements)

References 38 publications

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“…This may be partly explained by the load dependency of GLS, where an increase in SV and concomitant increase in EDV, as seen in AR, will have opposing effects on GLS [26,27]. The same observation was made by Vollema et al, who suggested that the finding was related to the Frank-Starling mechanism; hence, a reduction in preload will lead to a decrease in myocardial contraction force and consequently GLS [28]. The interaction between GLS and loading conditions was also evident in a study of 47 patients with AR undergoing valve surgery, in whom the absolute GLS decreased after surgery, whereas the normalized GLS calculated as the GLS/EDV ratio increased, primarily driven by a reduction in EDV after surgery [29].…”

Section: Systolic LV Functionmentioning

confidence: 68%

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Jenner

Ilami

Petrini

et al. 2021

Cardiovasc Ultrasound

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Background The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed the structural and functional effects of severe AR on LV and left atrium before and after aortic valve replacement. Methods Patients with severe AR scheduled for aortic valve replacement (n = 65) underwent two- and three-dimensional echocardiography, including left atrial strain imaging, before and 1 year after surgery. A control group was selected, and comprised patients undergoing surgery for thoracic aortic aneurysm without aortic valve replacement (n = 20). Logistic regression analysis was used to assess predictors of impaired left ventricular functional and structural recovery, defined as a composite variable of diastolic dysfunction grade ≥ 2, EF < 50%, or left ventricular end-diastolic volume index above the gender-specific normal range. Results Diastolic dysfunction was present in 32% of patients with AR at baseline. Diastolic LV function indices and left atrial strain improved, and both left atrial and LV volumes decreased in the AR group following aortic valve replacement. Preoperative left atrial strain during the conduit phase added to left ventricular end-systolic volume index for the prediction of impaired LV functional and structural recovery after aortic valve replacement (model p < 0.001, accuracy 70%; addition of left atrial strain during the conduit phase to end-systolic volume index p = 0.006). Conclusions One-third of patients with severe AR had signs of diastolic dysfunction. Aortic valve surgery reduced LV and left atrial volumes and improved diastolic indices. Left atrial strain during the conduit phase added to the well-established left ventricular end-diastolic dimension for the prediction of impaired left ventricular functional and structural recovery at follow-up. However, long-term follow-up studies with hard endpoints are needed to assess the value of left atrial strain as predictor of myocardial recovery in aortic regurgitation.

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Section: Systolic LV Functionmentioning

confidence: 68%

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Jenner

Ilami

Petrini

et al. 2021

Cardiovasc Ultrasound

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“…In our study, we followed-up our groups in 6.77±2.05 months. Despite the fact that LVMR after AVR appeared in both aortic stenosis and regurgitation cases [28], complete LVMR can be reached in a 2 and 5 year period, respectively. A similar trend was observed in our study, where the LVM of AS patients regressed better in the same follow-up time compared to AR patents.…”

Section: Discussionmentioning

confidence: 89%

The relationship between myocardial fibrosis and left ventricular remodeling following aortic valve replacement

Aitaliyev¹,

Rumbinaitė²,

Nekrošius³

et al. 2021

J CLIN MED KAZ

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Aortic valve diseases are associated with myocardial fibrosis. The relationship between severity of myocardial fibrosis and left ventricular mass reduction (LVMR) after aortic valve replacement (AVR) still needs to be elucidated.Material and methods: In a single-center, retrospective trial, 130 patients underwent AVR with/without concomitant surgery. The study population was divided by etiology into aortic stenosis (AS) and aortic regurgitation (AR) groups. LV end-diastolic diameter, LV septal and posterior thicknesses, LV mass, and aortic annulus were obtained in all study patients. Left ventricular mass regression index (iLVMR) was found by the difference between preoperative iLVM and follow-up iLVM. iLVMR in months was calculated by divided iLVMR on the number of months before follow-up visit. Myocardial tissue was embedded in paraffin, and sectioned into 4 µm slices for histological staining (picrosirius red) and scanning. The fraction of myocardial volume occupied by collagen tissue was determined.Results: The left ventricular remodeling of AS and AR patients is presented in Table 3. There was significant LV mass reduction in both aortic valve disease groups in the follow-up period (AS group, p<0.001; AR group, p<0.05). The number of LVH cases decreased in both groups in the follow-up period (AS group, p<0.001; AR group, p<0.05). In Post-AVR period the ejection fraction of LV did not improve in the AS group, compare to AR group (p<0.05). In both groups number of patients with impaired LV EF was increased in Post-AVR period, but not significantly. Moreover, the LV septal thickness, and iLVEDD significantly decreased in the AS group (p<0.001 and p<0.001), compared to the AR group (p=NS, p<0.05).We did not found correlations between MF and LVM in preoperative, and follow-up periods for AS and AR groups. Moreover, MF did not correlate significantly to iLVMR and iLVMR in months. A significant correlation exists in AS patients between MF and preoperative iLVEDD (r =0.21, p=0.04). Conclusion:The LVM reduction was observed in both AS and AR groups. LVM of AS group recovered more quickly than that of AR group. In our study MF does not affect LVM regression. Large cohort of patients with myocardial biopsies and long-term follow-up are needed to access the impact of the MF on the LVMR.

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“…Moreover, Une et al [ 21 ] showed that LV mass regression in both patients with aortic stenosis (AS) and those with aortic regurgitation (AR) occurred at a steep decline over 2 years after AVR. Vollema et al [ 22 ] reported that LV mass regression and changes in LV global longitudinal strain were similar despite different preoperative LV remodeling in patients with AS and those with AR. These findings are consistent with our results.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

Kim

Lee

Joo

et al. 2021

JCM

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The Trifecta valve has externally mounted leaflets; it differs from classic internally mounted valves (e.g., Carpentier-Edwards [C-E]). We evaluated post-implantation hemodynamics and clinical outcomes of these bioprostheses in small aortic annuli. From January 2015 to April 2019, 490 patients who underwent aortic valve replacement (AVR) were reviewed retrospectively. Altogether, 183 patients received 19 or 21 mm diameter C-E (n = 121) or Trifecta (n = 62) prostheses. To minimize confounding variables, we performed propensity-score matching analysis. The mean transvalvular pressure gradient (TVPG) was significantly lower in the Trifecta than in the C-E group at discharge (12.9 ± 4.8 vs. 15.0 ± 5.3 mmHg, p = 0.044). TVPG change over time was not significantly different between groups (p = 0.357). Left ventricular mass index decreased postoperatively (reduction: C-E, 28.1%; Trifecta, 30.1%, p = 0.879). No late mortality, severe patient–prosthesis mismatch, moderate-to-severe paravalvular leakage, structural valve degeneration, or valve thromboses were observed. Freedom from valve-related events at 3 years were similar for C-E (97.9% ± 2.1%) and Trifecta (97.7% ± 2.2%) patients (log-rank p = 0.993). Bioprosthesis design for small annuli significantly affected TVPG immediately after AVR. However, hemodynamics over time and clinical outcomes did not differ between the two designs.

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

Cited by 30 publications

References 38 publications

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

The relationship between myocardial fibrosis and left ventricular remodeling following aortic valve replacement

A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

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