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Patients at risk for cardiac death late after aortic valve replacement
1Department of Internal Medicine, University Hospital, Basel, Switzerland.
Insights
Left ventricular hypertrophy (LVH) and repetitive ventricular premature beats (VPBs) after aortic valve replacement signal increased cardiac mortality risk. These findings highlight their role as noninvasive markers for left ventricular dysfunction.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Aortic valve replacement (AVR) is a common procedure.
- Post-operative cardiac complications require identification of predictive markers.
- Left ventricular hypertrophy (LVH) and ventricular premature beats (VPBs) are potential indicators of cardiac health post-AVR.
Purpose of the Study:
- To investigate the association between LVH and VPBs with cardiac mortality after AVR.
- To evaluate LVH and VPBs as noninvasive markers of left ventricular dysfunction post-AVR.
Main Methods:
- Prospective screening of 100 patients post-AVR for LVH (ECG Estes scores ≥5.0) and VPBs (≥2 couplets/24hr Holter).
- 41-month follow-up to assess cardiac mortality rates.
- Statistical analysis using chi-squared test.
Main Results:
- Yearly cardiac mortality rates: 1.3% (LVH), 2.9% (VPBs), 8.0% (LVH + VPBs), 0.6% (none).
- LVH and VPBs were more frequent in patients with left ventricular dysfunction.
- No significant differences in age, time since operation, valve lesion, or CAD between groups.
Conclusions:
- Cardiac mortality is significantly increased in AVR patients with LVH and repetitive VPBs.
- LVH and VPBs serve as valuable noninvasive markers for left ventricular dysfunction post-AVR.
- Identifying these markers can aid in risk stratification and patient management post-AVR.
Abstract:
A total of 100 patients aged 24 to 78 years were screened prospectively a mean of 71 months after aortic valve replacement for the presence of left ventricular hypertrophy (LVH) on the ECG (Estes scores greater than or equal to 5.0) and for repetitive ventricular premature beats VPBs greater than or equal to 2 couplets/24 hr) during 24-hour Holter monitoring. During the subsequent 41-month follow-up (range 10 to 50 months), the yearly cardiac mortality rate was 1.3% in patients with LVH, 2.9% in patients with VPBs, and 8.0% in patients with LVH plus VPBs but only 0.6% when none of these factors was present (p less than 0.05 chi 2 test). The patient groups did not differ with regard to age, time elapsed since operation, underlying valve lesion, and coronary artery disease. Both LVH and VPBs occurred more frequently in patients with left ventricular dysfunction. We conclude that after aortic valve replacement cardiac mortality is markedly increased in patients with LVH and repetitive VPBs, since they are noninvasive markers of left ventricular dysfunction.