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Ventricular hypertrophy and left atrial dilatation persist and are associated with reduced survival after valve replacement for aortic stenosis
Citation
Beach, JM and Mihaljevic, T and Rajeswaran, J and Marwick, T and Edwards, ST and Nowicki, ER and Thomas, J and Svensson, LG and Griffin, B and Gillinov, AM and Blackstone, EH, Ventricular hypertrophy and left atrial dilatation persist and are associated with reduced survival after valve replacement for aortic stenosis, The Journal of Thoracic and Cardiovascular Surgery, 147, (1) pp. 362-369. ISSN 0022-5223 (2014) [Refereed Article]
DOI: doi:10.1016/j.jtcvs.2012.12.016
Abstract
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 ± 42 g/m(2) preoperatively to 115 ± 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 < .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.
Item Details
| Item Type: | Refereed Article |
|---|---|
| Research Division: | Biomedical and Clinical Sciences |
| Research Group: | Cardiovascular medicine and haematology |
| Research Field: | Cardiology (incl. cardiovascular diseases) |
| Objective Division: | Health |
| Objective Group: | Clinical health |
| Objective Field: | Clinical health not elsewhere classified |
| UTAS Author: | Marwick, T (Professor Tom Marwick) |
| ID Code: | 87843 |
| Year Published: | 2014 |
| Web of Science® Times Cited: | 101 |
| Deposited By: | Menzies Institute for Medical Research |
| Deposited On: | 2013-12-11 |
| Last Modified: | 2014-04-02 |
| Downloads: | 0 |
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