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Interaction and prognostic effects of left ventricular diastolic dysfunction and patient-prosthesis mismatch as

Joseph Brown1, Pallav Shah, Tony Stanton

  • 1School of Medicine, University of Queensland, Brisbane, Australia.

The American Journal of Cardiology
|August 25, 2009
PubMed

Insights

Patient-prosthesis mismatch (P-PM) effects are variable. This study found that left ventricular diastolic dysfunction (DD), not P-PM, significantly impacts outcomes after aortic valve replacement, highlighting DD as a critical factor for patient prognosis.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Patient-prosthesis mismatch (P-PM) has variable reported effects on outcomes after aortic valve replacement.
  • It is hypothesized that left ventricular diastolic dysfunction (DD) contributes to adverse outcomes attributed to P-PM, particularly in patients with smaller hearts.

Purpose of the Study:

  • To determine the association among P-PM, DD, and patient outcomes following aortic valve replacement.
  • To investigate whether DD is the primary driver of adverse events in patients with P-PM.

Main Methods:

  • Doppler echocardiography was performed in 156 patients post-aortic valve replacement.
  • P-PM was identified using in vivo effective orifice areas and published reference values.
  • Diastolic dysfunction (DD) was classified into normal, delayed relaxation, or increased left atrial pressure categories.

Main Results:

  • P-PM was present in 58% of patients.
  • Diastolic dysfunction (DD) was significantly associated with adverse events (p = 0.034), including cardiac hospitalizations and all-cause mortality.
  • In patients with P-PM, the incidence of events was higher in those with delayed relaxation (42%) and increased left atrial pressure (51%) compared to no DD (7%).

Conclusions:

  • Adverse outcomes after aortic valve replacement are significantly associated with left ventricular diastolic dysfunction (DD).
  • The presence of P-PM alone was not significantly associated with adverse events in this cohort.
  • Diastolic dysfunction is a critical determinant of prognosis in patients undergoing aortic valve replacement.

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