Predictor of left ventricular dysfunction after aortic valve replacement in mixed aortic valve disease

Alexander Egbe, Carole A. Warnes

Research output: Contribution to journalArticle

3 Citations (Scopus)

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 5 years 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 5 years 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 ± 8 years, 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.

Original languageEnglish (US)
Pages (from-to)511-517
Number of pages7
JournalInternational Journal of Cardiology
Volume228
DOIs
StatePublished - Feb 1 2017

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Aortic Diseases
Left Ventricular Dysfunction
Aortic Valve
Heart Ventricles
Coronary Artery Disease
Aortic Valve Insufficiency
Aortic Valve Stenosis
Blood Pressure

Keywords

  • Aortic valve replacement
  • Left ventricle dysfunction
  • Left ventricular mass
  • Mixed aortic valve disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictor of left ventricular dysfunction after aortic valve replacement in mixed aortic valve disease. / Egbe, Alexander; Warnes, Carole A.

In: International Journal of Cardiology, Vol. 228, 01.02.2017, p. 511-517.

Research output: Contribution to journalArticle

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title = "Predictor of left ventricular dysfunction after aortic valve replacement in mixed aortic valve disease",
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 5 years 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 5 years 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 ± 8 years, 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.",
keywords = "Aortic valve replacement, Left ventricle dysfunction, Left ventricular mass, Mixed aortic valve disease",
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AU - Warnes, Carole A.

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AB - 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 5 years 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 5 years 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 ± 8 years, 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.

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