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Published on: December 11, 2017
Effect of Preoperative Left Ventricular Mass on Outcomes After Aortic Valve Replacement for Aortic Regurgitation
Kohei Hachiro1, Noriyuki Takashima1, Kenichi Kamiya1
1Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science.
Insights
A left ventricular mass index (LVMI) above 200 g/m² predicts a higher risk of major adverse cardiac and cerebrovascular events (MACCE) after aortic valve replacement for aortic regurgitation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Imaging
Background:
- Aortic regurgitation (AR) necessitates aortic valve replacement (AVR).
- Left ventricular mass index (LVMI) is a key indicator of cardiac remodeling.
- The prognostic value of LVMI in AVR for AR requires further elucidation.
Purpose of the Study:
- To establish the optimal LVMI cut-off value for predicting major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing AVR for AR.
- To assess the impact of preoperative left ventricular remodeling on long-term postoperative outcomes.
Main Methods:
- Retrospective analysis of 263 patients who underwent surgical AVR for AR.
- Receiver operating characteristic (ROC) curve analysis to determine the LVMI cut-off value.
- Inverse probability of treatment weighting (IPTW) to adjust for preoperative characteristics.
Main Results:
- The optimal preoperative LVMI cut-off value for MACCE prediction was identified as 200 g/m² (AUC=0.692).
- Patients with LVMI >200 g/m² (n=92) exhibited a significantly higher 10-year MACCE rate (25.6%) compared to those with LVMI ≤200 g/m² (n=171, 13.5%; P=0.020).
- Preoperative LVMI >200 g/m² was independently associated with increased MACCE risk (HR 2.356; P=0.006).
Conclusions:
- Preoperative LVMI exceeding 200 g/m² is a significant predictor of MACCE in patients undergoing AVR for AR.
- Elevated LVMI indicates substantial left ventricular remodeling, associated with poorer long-term prognosis post-AVR.
- LVMI measurement should be integrated into risk stratification for patients with AR undergoing AVR.
Background:
We determined the left ventricular mass index (LVMI) cut-off value for the risk of major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing aortic valve replacement (AVR) for aortic regurgitation (AR) and investigated the effect of preoperative left ventricular remodeling on long-term outcomes postoperatively.
Methods And Results:
Of the 1,580 patients who underwent surgical AVR at Shiga University of Medical Science between January 2002 and December 2022, we retrospectively analyzed data for 263 patients who underwent surgery for AR. The receiver operating characteristic curve showed that the cut-off value of preoperative LVMI for the incidence of MACCE was 200 g/m2(area under the curve=0.692). We compared postoperative outcomes between patients with preoperative LVMI >200 g/m2(n=92) and those with preoperative LVMI ≤200 g/m2(n=171) after adjusting for preoperative characteristics using inverse probability of treatment weighting. The mean (±SD) follow-up period was 6.9±5.1 years. The rate of MACCE at 10 years was significantly higher in patients with preoperative LVMI >200 g/m2than in those with preoperative LVMI ≤200 g/m2(25.6% vs. 13.5%; P=0.020). In multivariable Cox models, preoperative LVMI >200 g/m2was significantly associated with a higher risk of MACCE (hazard ratio 2.356, P=0.006).
Conclusions:
Preoperative LVMI >200 g/m2was associated with a higher rate of MACCE in patients undergoing AVR for AR.
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