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Updated: May 5, 2026
Reduction in Left Ventricular Wall Stress and Improvement in Function in Failing Hearts using Algisyl-LVR
Published on: April 8, 2013
Myocardial structure as a determinant of pre- and postoperative ventricular function and long-term prognosis after
O Lund1, L H Kristensen, U Baandrup
1Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby Sygehus, Denmark.
Insights
Left ventricular myocardial abnormalities predict outcomes after aortic valve replacement for aortic stenosis. Muscle cell hypertrophy and nucleus volume impact patient prognosis and ventricular function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Pathology
Background:
- Long-term outcomes of aortic valve replacement for aortic stenosis are linked to pre-operative cardiac risk.
- Predictability suggests underlying structural abnormalities in left ventricular myocardium.
Purpose of the Study:
- To investigate the relationship between left ventricular myocardial structure and clinical outcomes in patients undergoing aortic valve replacement for aortic stenosis.
- To identify morphological predictors of ventricular function and mortality.
Main Methods:
- Transmural biopsies of the left ventricle were obtained during aortic valve replacement in 49 patients with aortic stenosis.
- Echocardiography and radionuclide ventriculography assessed cardiac function pre-operatively and 18 months post-operatively.
- Morphological data included left ventricular mass index, muscle cell diameter, nucleus volume, muscle cell mass index, and fibrous tissue mass index.
Main Results:
- Pre-operatively, all patients showed increased left ventricular mass index and muscle cell diameter.
- Patients with prior left ventricular failure had significantly greater morphological abnormalities.
- Muscle cell nucleus volume independently predicted early and late mortality.
- Post-operatively, left ventricular mass index decreased, but remained correlated with morphology.
Conclusions:
- Hypertrophied left ventricular muscle cell abnormalities determine pre-operative symptoms, ventricular function, and mortality after aortic valve replacement.
- Incomplete hypertrophy, linked to myocardial structural abnormalities, impaired patient outcomes.
Background:
Long-term results after aortic value replacement for aortic stenosis can be correlated to a cardiac-related pre-operative risk profile. This predictability indicates that there is a common basis in subtle or overt structural abnormalities of left ventricular myocardium.
Methods And Results:
Forty-nine patients aged 24-82 (mean 61) years, with aortic stenosis had a full wall thickness transmural biopsy of the left ventricular antero-lateral free wall during aortic valve replacement. Echocardiography and radionuclide ventriculography were performed prior to, and 18 months (n = 41) after, the operation. Postoperative follow-up to a maximum of 7.7 years was 100% complete. Pre-operatively, all patients had an increase in both the left ventricular mass index (202 +/- 67 g.m-2) and the muscle cell diameter (41 +/- 8 microns); other morphological data included a muscle cell nucleus volume of 752 +/- 192 microns3, a muscle cell mass index of 163 +/- 54.m-2, and a fibrous tissue mass index of 39 +/- 16 g.m-2. Patients with a pre-operative episode of clinical left ventricular failure (n = 19) had significantly greater morphological variables than those without. Pre-operative ejection fraction and other measures of systolic function correlated inversely with the morphological data, except for the fibrous tissue mass index; diastolic function indices correlated inversely with all the morphological variables. At the 18-month re-study, the same general picture was noted, but with an underlying strengthening, especially of the muscle cell mass index. Overall, the mass index dropped to 152 +/- 51 g.m-2 (P < 0.0001), but in 17% of the patients it became normal; the mass index at 18 months was directly correlated to morphological variables. A high muscle cell nucleus volume was identified as an independent predictor of early and late mortality.
Conclusions:
Abnormalities of the hypertrophied left ventricular muscle cell and the degree of muscle hypertrophy are, to some degree, underlying determinants of pre-operative symptomatology, pre- and postoperative ventricular function, and early and late mortality after valve replacement for aortic stenosis. Incomplete hypertrophy impaired results, was related to pre-operative myocardial structural abnormalities.
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