Related Experiment Video
Updated: Jan 3, 2026
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Predictive value of left ventricular diastolic chamber stiffness in patients with severe aortic stenosis undergoing
Vidhu Anand1, Rosalyn O Adigun1, Jeremy T Thaden1
1Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Insights
Left ventricular chamber stiffening, a measure of heart muscle stiffness, predicts worse outcomes after aortic valve replacement surgery for severe aortic stenosis. Higher stiffness indicates a greater risk of mortality, even after successful valve replacement.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Long-term mortality remains elevated in some patients post-aortic valve replacement (AVR).
- Limited data exist on the prognostic significance of left ventricular (LV) chamber stiffening in these patients.
Purpose of the Study:
- To investigate the prognostic role of LV chamber stiffness in patients with severe aortic stenosis (AS) undergoing AVR.
Main Methods:
- Retrospective analysis of 1893 patients with severe AS undergoing AVR.
- Reconstruction of LV end-diastolic pressure-volume relations (EDPVR) from echocardiographic data.
- Evaluation of LV chamber stiffness (CS30) and its association with all-cause mortality.
Main Results:
- Higher preoperative LV chamber stiffness (CS30 > 2 mmHg/mL) was observed in 46% of patients.
- Increased LV stiffness was associated with older age, female sex, and more comorbidities.
- Higher CS30 was a significant independent predictor of poorer survival post-AVR (HR 2.7, P < 0.0001), irrespective of ejection fraction.
Conclusions:
- Preoperative LV chamber stiffening is a significant independent predictor of adverse outcomes after AVR in patients with severe AS.
- Higher LV stiffness is linked to poorer survival, even with successful valve replacement.
Aims:
Despite improvements in cardiac haemodynamics and symptoms, long-term mortality remains increased in some patients after aortic valve replacement (AVR). Limited data exist on the prognostic role of left ventricular (LV) chamber stiffening in these patients.
Methods And Results:
We performed a retrospective analysis in 1893 patients with severe aortic stenosis (AS) referred for AVR. LV end-diastolic pressure-volume relations (EDPVR, P = αV^β) were reconstructed from echocardiographic measurements of end-diastolic volumes and estimates of end-diastolic pressure (EDP). The impact of EDPVR-derived LV chamber stiffness (CS30, at 30 mmHg EDP) on all-cause mortality after AVR was evaluated. Mean age was 76 ± 10 years, 39% were females, and ejection fraction (EF) was 61 ± 12%. The mean LV chamber stiffness (CS30) was 2.2 ± 1.3 mmHg/mL. A total of 877 (46%) patients had high LV stiffness (CS30 >2 mmHg/mL). In these patients, the EDPVR curves were steeper and shifted leftwards, indicating higher stiffness at all pressure levels. These patients were slightly older, more often female, and had more prevalent comorbidities compared to patients with low stiffness. At follow-up [median 4.2 (interquartile range 2.8-6.3) years; 675 deaths], a higher CS30 was associated with lower survival (hazard ratio: 2.7 for severe vs. mild LV stiffening; P < 0.0001), both in patients with normal or reduced EF. At multivariate analysis, CS30 remained an independent predictor, even after adjusting for age, sex, comorbidities, EF, LV remodelling, and diastolic dysfunction.
Conclusion:
Higher preoperative LV chamber stiffening in patients with severe AS is associated with poorer outcome despite successful AVR.
Related Concept Videos
01:25Aortic Regurgitation III: Medical Management
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:22Mitral Stenosis I: Introduction
01:15Aortic Regurgitation I: Introduction