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Regression of left ventricular mass one year after aortic valve replacement for pure severe aortic stenosis
Harald P Kühl1, Andreas Franke, David Puschmann
1Medizinische Klinik I, Aachen, Germany. hkuehl@post.klinikum.rwth-aachen.de
Insights
Left ventricular mass index (LVMI) regression after aortic stenosis treatment improves patient function. Most patients achieve normal LVMI, especially those with good preoperative function, indicating positive outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiac Surgery
Background:
- Severe aortic stenosis often leads to left ventricular (LV) hypertrophy.
- Understanding the regression of LV mass and improvement in LV function post-treatment is crucial for patient outcomes.
- Serial 3-dimensional echocardiography offers detailed assessment of cardiac remodeling.
Purpose of the Study:
- To quantify the 1-year change in left ventricular mass index (LVMI) and systolic LV function in patients with severe aortic stenosis.
- To assess the extent of LVMI regression and its relationship with preoperative factors and functional status.
- To compare postoperative LVMI with control subjects to evaluate normalization.
Main Methods:
- Serial 3-dimensional echocardiography was used in 30 patients with pure severe aortic stenosis.
- Measurements included LV mass index (LVMI) and ejection fraction before and 1 year after treatment.
- Postoperative LVMI was compared to 30 normotensive control subjects.
Main Results:
- LVMI regressed by 23.4% (p <0.001) within 1 year, with 64% of patients achieving normal LVMI.
- Ejection fraction improved (p = 0.067) and functional class significantly improved (p <0.05) in all patients.
- Reduced preoperative LV function was associated with larger baseline volumes and mass, and less likelihood of normalizing LVMI.
Conclusions:
- Regression of LVMI is a positive and consistent event following treatment for aortic stenosis, linked to functional improvement.
- Normalization of LVMI is more likely in patients with normal preoperative LV function.
- Preoperative LV function is a key predictor of LVMI normalization, independent of patient gender, valve type, or size.
Abstract:
The aim of the study was to quantify a 1-year change in left ventricular (LV) mass index (MI) and systolic LV function in 30 patients with pure severe aortic stenosis by means of serial 3-dimensional (3-D) echocardiography. To assess the completeness of LVMI regression after 1 year, we compared the postoperative mass of patients with mass values of 30 normotensive control subjects without a history of cardiac disease. Ejection fraction increased from 64 +/- 14% before surgery to 69 +/- 8% at follow-up (p = 0.067), and functional class improved from 2.9 +/- 0.5 to 1.4 +/- 0.5 (p <0.05), with improvement in each patient. During the same period, LVMI regressed by 23.4% (p <0.001). Postoperative LVMI was related to preoperative LVMI (r = 0.82; p <0.001) and baseline ejection fraction (r = -0.5; p = 0.009). LVMI regressed into the normal range in 64% of patients at follow-up. Patients achieving normal mass values did not differ with respect to patient gender, valve type, or valve size. Patients with reduced preoperative LV function had larger volumes (p <0.01), larger mass values (p <0.01), and a trend toward more mass regression (p = 0.062) than patients with normal preoperative function. Although ejection fraction improved after 1 year in all of these patients (p <0.03), they were less likely to achieve normal mass values at follow-up (p = 0.01). Regression of LVMI in patients with pure aortic stenosis is a positive event that occurs in each patient and that is associated with improvement in functional status. LVMI regressed into the normal range in most patients with normal preoperative function. Preoperative LV function, but not patient gender, valve type, or size, was related to normalization of LVMI at follow-up in this selected study population.