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Predictor of left ventricular dysfunction after aortic valve replacement in mixed aortic valve disease.
Int J Cardiol 2017; 228:511-517IJ

Abstract

BACKGROUND

The fate of the left ventricle (LV) after aortic valve replacement (AVR) in mixed aortic valve disease (MAVD) is unknown.

METHODS

Patients with moderate-severe MAVD, ejection fraction ≥50%, and no coronary artery disease who underwent AVR were identified. Moderate-severe MAVD was defined as a combination of ≥moderate aortic stenosis and ≥moderate aortic regurgitation. Assessment for LVD was performed at 1 and 5years after AVR. The purpose of the study was to determine prevalence and predictors of early and late left ventricular dysfunction (LVD) defined as ejection fraction <50% at 1 and 5years post-AVR. The severity of LV hypertrophy was assessed using LV mass index (LVMI), while relative wall thickness (RWT) was used to determine the type of hypertrophy. RWT was calculated as (2×posterior wall thickness)/LV end-diastolic dimension (LVEDD). A RWT score ≥0.42 and <0.42 indicates concentric and eccentric hypertrophy respectively.

RESULTS

Patients with MAVD (n=179); age 63±8years, males 134 (75%); underwent AVR at Mayo Clinic, 1994-2010. Early LVD occurred in 38(21%). Predictors of early LVD were LVMI/LVEDD >3.1 (HR 1.83, CI 1.59-1.98); RWT >0.46 (HR 2.16, CI 1.21-4.99); and older age (HR 1.62, CI 1.23-3.02). Assessment of LV function was performed in 124 patients at 5-years post-AVR, and late LVD was present in 29(23%). Predictors of late LVD were LVMI/LVEDD >3.1 (HR 1.77, CI 1.24-2.01) and RWT >0.46 (HR 1.65, CI 1.29-2.24). All-cause mortality occurred in 21(12%), and was more common in patients with LVMI/LVEDD >3.1 (P=0.043) and RWT >0.46 (P=0.029). Patients with postoperative LVD showed less regression of LV mass after AVR even after controlling for blood pressure.

CONCLUSIONS

LVD can occur after AVR even in the setting of normal preoperative LV function and absence of coronary artery disease. Preoperative LV mass was predictive of LVD and should be taken into consideration when determining the timing of AVR.

Authors+Show Affiliations

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: egbe.alexander@mayo.edu.Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: warnes.carole@mayo.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27875727

Citation

Egbe, Alexander C., and Carole A. Warnes. "Predictor of Left Ventricular Dysfunction After Aortic Valve Replacement in Mixed Aortic Valve Disease." International Journal of Cardiology, vol. 228, 2017, pp. 511-517.
Egbe AC, Warnes CA. Predictor of left ventricular dysfunction after aortic valve replacement in mixed aortic valve disease. Int J Cardiol. 2017;228:511-517.
Egbe, A. C., & Warnes, C. A. (2017). Predictor of left ventricular dysfunction after aortic valve replacement in mixed aortic valve disease. International Journal of Cardiology, 228, pp. 511-517. doi:10.1016/j.ijcard.2016.11.237.
Egbe AC, Warnes CA. Predictor of Left Ventricular Dysfunction After Aortic Valve Replacement in Mixed Aortic Valve Disease. Int J Cardiol. 2017 Feb 1;228:511-517. PubMed PMID: 27875727.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictor of left ventricular dysfunction after aortic valve replacement in mixed aortic valve disease. AU - Egbe,Alexander C, AU - Warnes,Carole A, Y1 - 2016/11/14/ PY - 2016/07/02/received PY - 2016/11/05/revised PY - 2016/11/10/accepted PY - 2016/11/23/pubmed PY - 2017/11/10/medline PY - 2016/11/23/entrez KW - Aortic valve replacement KW - Left ventricle dysfunction KW - Left ventricular mass KW - Mixed aortic valve disease SP - 511 EP - 517 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 228 N2 - BACKGROUND: The fate of the left ventricle (LV) after aortic valve replacement (AVR) in mixed aortic valve disease (MAVD) is unknown. METHODS: Patients with moderate-severe MAVD, ejection fraction ≥50%, and no coronary artery disease who underwent AVR were identified. Moderate-severe MAVD was defined as a combination of ≥moderate aortic stenosis and ≥moderate aortic regurgitation. Assessment for LVD was performed at 1 and 5years after AVR. The purpose of the study was to determine prevalence and predictors of early and late left ventricular dysfunction (LVD) defined as ejection fraction <50% at 1 and 5years post-AVR. The severity of LV hypertrophy was assessed using LV mass index (LVMI), while relative wall thickness (RWT) was used to determine the type of hypertrophy. RWT was calculated as (2×posterior wall thickness)/LV end-diastolic dimension (LVEDD). A RWT score ≥0.42 and <0.42 indicates concentric and eccentric hypertrophy respectively. RESULTS: Patients with MAVD (n=179); age 63±8years, males 134 (75%); underwent AVR at Mayo Clinic, 1994-2010. Early LVD occurred in 38(21%). Predictors of early LVD were LVMI/LVEDD >3.1 (HR 1.83, CI 1.59-1.98); RWT >0.46 (HR 2.16, CI 1.21-4.99); and older age (HR 1.62, CI 1.23-3.02). Assessment of LV function was performed in 124 patients at 5-years post-AVR, and late LVD was present in 29(23%). Predictors of late LVD were LVMI/LVEDD >3.1 (HR 1.77, CI 1.24-2.01) and RWT >0.46 (HR 1.65, CI 1.29-2.24). All-cause mortality occurred in 21(12%), and was more common in patients with LVMI/LVEDD >3.1 (P=0.043) and RWT >0.46 (P=0.029). Patients with postoperative LVD showed less regression of LV mass after AVR even after controlling for blood pressure. CONCLUSIONS: LVD can occur after AVR even in the setting of normal preoperative LV function and absence of coronary artery disease. Preoperative LV mass was predictive of LVD and should be taken into consideration when determining the timing of AVR. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/27875727/Predictor_of_left_ventricular_dysfunction_after_aortic_valve_replacement_in_mixed_aortic_valve_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(16)33777-9 DB - PRIME DP - Unbound Medicine ER -