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Diastolic versus Systolic Left Ventricular Dysfunction as Independent Predictors for Unfavorable Postoperative

Luminita Iliuta1,2, Andreea Gabriella Andronesi3,4, Camelia Cristina Diaconu5,6,7

  • 1Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.

Medicina (Kaunas, Lithuania)
|November 24, 2022
PubMed

Insights

A restrictive left ventricle diastolic filling pattern (LVDFP) significantly increases early and medium-term mortality after aortic valve replacement for severe aortic regurgitation. This diastolic dysfunction is a more reliable prognostic indicator than left ventricle systolic performance.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiac Surgery

Background:

  • Severe aortic regurgitation (AR) causes significant left ventricle (LV) remodeling.
  • Assessing LV performance is crucial for predicting outcomes in AR patients undergoing aortic valve replacement (AVR).

Purpose of the Study:

  • To evaluate the prognostic value of LV diastolic filling patterns (LVDFP) versus LV systolic performance in severe AR patients undergoing AVR.
  • To identify independent echocardiographic predictors of early and long-term prognosis.

Main Methods:

  • Prospective study of 332 severe AR patients undergoing AVR.
  • Patients were categorized by LV systolic function (normal vs. dysfunction) and LVDFP (nonrestrictive vs. restrictive).
  • Echocardiographic parameters including E/A ratio, E wave deceleration time, isovolumetric relaxation time, and pulmonary vein flow S/D ratio were analyzed.

Main Results:

  • Restrictive LVDFP was associated with significantly higher early postoperative mortality (11.12-12.5%) compared to nonrestrictive LVDFP (2.32-7.63%), irrespective of LVEF.
  • Restrictive LVDFP independently predicted early mortality (RR 8.2-fold).
  • Other early predictors included LV end-systolic diameter > 58 mm, age > 75 years, and comorbidities. Medium-term unfavorable outcomes were linked to age > 75, LV end-systolic volume > 95 cm³, restrictive LVDFP, and pulmonary hypertension.

Conclusions:

  • Restrictive LVDFP is a significant independent predictor of both early and medium-term mortality in severe AR patients undergoing AVR.
  • LV diastolic function is a more potent prognostic marker than LV systolic performance in this population.
  • Age, LV dimensions, and comorbidities also influence postoperative outcomes.

Keywords:
aortic regurgitationaortic valve replacementdiastolic dysfunctionrestrictive diastolic patternsystolic dysfunction

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