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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:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, T (Professor Tom Marwick)
ID Code:87843
Year Published:2014
Web of Science® Times Cited:46
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-12-11
Last Modified:2014-04-02
Downloads:0

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