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Interaction and prognostic effects of left ventricular diastolic dysfunction and patient-prosthesis mismatch as determinants of outcome after isolated aortic valve replacements
Citation
Brown, J and Shah, P and Stanton, T and Marwick, TH, Interaction and prognostic effects of left ventricular diastolic dysfunction and patient-prosthesis mismatch as determinants of outcome after isolated aortic valve replacements, The American Journal of Cardiology, 104, (5) pp. 707-712. ISSN 0002-9149 (2009) [Refereed Article]
Copyright Statement
Copyright 2009 Elsevier
DOI: doi:10.1016/j.amjcard.2009.04.035
Abstract
There are variable reported effects of patient-prosthesis mismatch (P-PM) on outcome. It
was hypothesized that the adverse effect attributed to P-PM is actually due to left ventricular
diastolic dysfunction (DD) in patients with small hearts. The aim of this study was
therefore to determine the association among P-PM, DD, and outcomes. Doppler echocardiography
was performed in 156 patients after aortic valve replacement. In vivo effective
orifice areas for each prosthesis type and size were obtained from published references
values of normally functioning prostheses. P-PM was identified from the predicted indexed
orifice area, obtained by dividing the effective orifice area by body surface area. DD was
classed as normal, delayed relaxation (prolonged deceleration time for age), or increased
left atrial pressure (increased E/E= ratio, left atrial enlargement, short deceleration time).
Events (cardiac-related hospitalizations and all-cause mortality after aortic valve replacement)
were determined over a median follow-up periods of 3.5 years (interquartile range 2.1
to 5.7). P-PM was found in 91 patients (58%). Of the patients with P-PM, no DD was
present on postoperative echocardiography in 15 patients (16%), delayed relaxation in 35
(39%), and increased left atrial pressure in 41 (45%). There were 61 total events (18 deaths
and 43 hospitalizations): 4 (7%) in the no-DD group, 26 (42%) in the delayed relaxation
group, and 31 (51%) in the increased left atrial pressure group. DD (p = 0.034) but not age
(p = 0.09), the left ventricular ejection fraction (p = 0.60), or the presence of mismatch
(p = 0.20) was associated with events. In conclusion, P-PM was associated with 14%
mortality and a 39% composite event rate over 2-year follow-up. Events were significantly
associated with DD.
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, TH (Professor Tom Marwick) |
ID Code: | 90763 |
Year Published: | 2009 |
Web of Science® Times Cited: | 7 |
Deposited By: | Menzies Institute for Medical Research |
Deposited On: | 2014-04-23 |
Last Modified: | 2014-12-17 |
Downloads: | 0 |
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