Ventricular hypertrophy and left atrial dilatation persist and are associated with reduced survival after valve replacement for聽aortic stenosis

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• 作者：Jocelyn M. Beach ; Tomislav Mihaljevic ; Jeevanantham Rajeswaran ; Thomas Marwick ; Samuel T. Edwards ; Edward R. Nowicki ; James Thomas ; Lars G. Svensson ; Brian Griffin ; A. Marc Gillinov ; Eugene H. Blackstone
• 关键词：AV ; aortic valve ; AVR ; AV replacement ; LA ; left atrial ; LV ; left ventricular ; LVEF ; LV ejection fraction ; LVMI ; LV mass index ; TTE ; transthoracic echocardiogram
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：January, 2014
• 年：2014
• 卷：147
• 期：1
• 页码：362-369.e8
• 全文大小：1925 K

文摘

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Objectives

We sought to understand the factors modulating left heart reverse remodeling after aortic valve replacement, the relationship between the preoperative symptoms and modulators of left heart remodeling, and their influence on long-term survival.

Methods

From October 1991 to January 2008, 4264 patients underwent primary aortic valve replacement for aortic stenosis. Changes in the time course of left ventricular reverse remodeling were assessed using 5740 postoperative transthoracic echocardiograms from 3841 patients.

Results

Left ventricular hypertrophy rapidly declined after surgery, from 137聽卤聽42 g/m² preoperatively to 115聽卤聽27 by 2 years and remained relatively constant but greater than the upper limit of normal. The most important risk factor for residual left ventricular hypertrophy was greater preoperative left ventricular hypertrophy (P聽<聽.0001). Other factors included a greater left atrial diameter (reflecting diastolic dysfunction), a lower ejection fraction, and male gender. An increased postoperative transprosthesis gradient was associated with greater residual left ventricular hypertrophy; however, its effect was minimal. Preoperative severe left ventricular hypertrophy and left atrial dilatation reduced long-term survival, independent of symptom status.

Conclusions

Severe left ventricular hypertrophy with left atrial dilatation can develop from severe aortic stenosis, even without symptoms. These changes can persist, are associated with decreased long-term survival even after successful aortic valve replacement, and could be indications for early aortic valve replacement if supported by findings from an appropriate prospective study.