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Left ventricular mass index in aortic valve surgery: a new index for early valve replacement?
Rafael García Fuster1, José A Montero Argudo, Oscar Gil Albarova
1University General Hospital of Valencia, Spain. rgfuster@terra.com
Insights
Increased left ventricular mass index is linked to worse outcomes and higher mortality after aortic valve replacement. Early intervention may improve results in patients with elevated left ventricular mass index.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Left ventricular mass index (LVMI) is a key indicator of cardiac health.
- Elevated LVMI is a known predictor of mortality in the general population.
- The impact of LVMI on outcomes following aortic valve replacement (AVR) requires further investigation.
Purpose of the Study:
- To evaluate the association between increased left ventricular mass index and postoperative outcomes in patients undergoing aortic valve replacement.
- To identify left ventricular mass index as an independent predictor of early mortality after AVR.
Main Methods:
- Echocardiographic data from 614 patients undergoing AVR between 1993 and 2001 were analyzed.
- Left ventricular mass index was calculated and defined as increased if above the superior decile (≥277 g/m² in males, ≥251 g/m² in females).
- Outcomes assessed included postoperative complications, hospital stay duration, and in-hospital mortality.
Main Results:
- 9.9% of patients had an increased left ventricular mass index.
- Patients with increased LVMI experienced higher rates of postoperative complications and mortality (11.4% vs. 3.2%, P<0.01).
- Increased LVMI was an independent predictor of early mortality (OR: 5.6; P=0.02), along with age, chronic renal failure, and cardiopulmonary bypass time.
Conclusions:
- Increased left ventricular mass index is significantly associated with adverse in-hospital outcomes and mortality in patients undergoing aortic valve replacement.
- Optimizing outcomes may involve addressing elevated LVMI before significant increases occur, potentially through earlier AVR.
- Further research is needed to confirm the utility of LVMI in guiding the timing of aortic valve replacement.
Objective:
Increased left ventricular mass index has been associated with higher mortality. We analyze the effect of increased left ventricular mass index on outcomes in patients undergoing aortic valve replacement.
Methods:
Echocardiographic left ventricular dimensions were used to calculate left ventricular mass index in 614 patients who underwent aortic valve replacement between June 1993 and November 2001. Left ventricular mass index was considered increased if higher than the value of the superior decile (277 g/m(2) in males and 251 in females).
Results:
Mean left ventricular mass index was: 178+/-111 g/m(2), and increased index was considered in 9.9% of patients. Postoperative complications (low cardiac output syndrome, respiratory failure, arrhythmias, pneumonia and mediastinitis), median length of hospital stay: 12 days (6-57) versus 11 days (5-51), and in-hospital mortality (11.4, 3.2%, P<0.01) were higher in patients with increased left ventricular mass index. Multivariable analysis identified increased left ventricular mass index (odds ratio: 5.6; 95% confidence interval: 1.2-25.0; P=0.02) and other three variables: age (P=0.04), history of chronic renal failure (P=0.03) and cardiopulmonary bypass time (P=0.004), as independent predictors of early mortality.
Conclusions:
Increased left ventricular mass index is associated with an in-hospital adverse outcome and a significantly higher in-hospital mortality in patients undergoing aortic valve replacement. Outcomes in asymptomatic patients could be improved before a clinically significant increase in left ventricular mass index. Further studies should be performed to determine the usefulness of this index in selecting patients for earlier aortic valve replacement.