Left ventricular reverse remodeling after aortic valve surgery for acute versus chronic aortic regurgitation

Abstract Aims Pressure overload in aortic stenosis (AS) and both pressure and volume overload in aortic regurgitation (AR) induce concentric and eccentric hypertrophy, respectively. These structural changes influence left ventricular (LV) mechanics, but little is known about the time course of LV remodelling and mechanics after aortic valve surgery (AVR) and its differences in AS vs. AR. The present study aimed to characterize the time course of LV mass index (LVMI) and LV mechanics [by LV global longitudinal strain (LV GLS)] after AVR in AS vs. AR. Methods and results Two hundred and eleven (61 ± 14 years, 61% male) patients with severe AS (63%) or AR (37%) undergoing surgical AVR with routine echocardiographic follow-up at 1, 2, and/or 5 years were evaluated. Before AVR, LVMI was larger in AR patients compared with AS. Both groups showed moderately impaired LV GLS, but preserved LV ejection fraction. After surgery, both groups showed LV mass regression, although a more pronounced decline was seen in AR patients. Improvement in LV GLS was observed in both groups, but characterized by an initial decline in AR patients while LV GLS in AS patients remained initially stable. Conclusion In severe AS and AR patients undergoing AVR, LV mass regression and changes in LV GLS are similar despite different LV remodelling before AVR. In AR, relief of volume overload led to reduction in LVMI and an initial decline in LV GLS. In contrast, relief of pressure overload in AS was characterized by a stable LV GLS and more sustained LV mass regression.

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Preoperative Longitudinal Left Ventricular Function by Tissue Doppler Echocardiography at Rest and During Exercise Is Valuable in Timing of Aortic Valve Surgery in Male Aortic Regurgitation Patients

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2010.01.013 ◽

2010 ◽

Vol 23 (4) ◽

pp. 387-395 ◽

Cited By ~ 12

Author(s):

Lena M. Helin ◽

Éva Tamás ◽

Eva Nylander

Keyword(s):

Aortic Valve ◽

Left Ventricular Function ◽

Ventricular Function ◽

Aortic Regurgitation ◽

Doppler Echocardiography ◽

Tissue Doppler ◽

Left Ventricular ◽

Valve Surgery ◽

Tissue Doppler Echocardiography ◽

Aortic Valve Surgery

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Predicting the need of aortic valve surgery in patients with chronic aortic regurgitation: a comparison between cardiovascular magnetic resonance imaging and transthoracic echocardiography

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02255-7 ◽

2021 ◽

Author(s):

M. Faber ◽

C. Sonne ◽

S. Rosner ◽

H. Persch ◽

W. Reinhard ◽

...

Keyword(s):

Magnetic Resonance ◽

Aortic Valve ◽

Aortic Regurgitation ◽

Transthoracic Echocardiography ◽

Magnetic Resonance Tomography ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Cardiac Magnetic Resonance Tomography ◽

Chronic Aortic Regurgitation

AbstractTo compare the ability of cardiac magnetic resonance tomography (CMR) and transthoracic echocardiography (TTE) to predict the need for valve surgery in patients with chronic aortic regurgitation on a mid-term basis. 66 individuals underwent assessment of aortic regurgitation (AR) both in CMR and TTE between August 2012 and April 2017. The follow-up rate was 76% with a median of 5.1 years. Cox proportional hazards method was used to assess the association of the time-to-aortic-valve-surgery, including valve replacement and reconstruction, and imaging parameters. A direct comparison of most predictive CMR and echocardiographic parameters was performed by using nested-factor-models. Sixteen patients (32%) were treated with aortic valve surgery during follow-up. Aortic valve insufficiency parameters, both of echocardiography and CMR, showed good discriminative and predictive power regarding the need of valve surgery. Within all examined parameters AR gradation derived by CMR correlated best with outcome [χ2 = 27.1; HR 12.2 (95% CI: 4.56, 36.8); (p < 0.0001)]. In direct comparison of both modalities, CMR assessment provided additive prognostic power beyond echocardiographic assessment of AR but not vice versa (improvement of χ2 from 21.4 to 28.4; p = 0.008). Nested model analysis demonstrated an overall better correlation with outcome by using both modalities compared with using echo alone with the best improvement in the moderate to severe AR range with an echo grade II out of III and a regurgitation fraction of 32% in CMR. This study corroborates the capability of CMR in direct quantification of AR and its role for guiding further treatment decisions particularly in patients with moderate AR in echocardiography.

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Utility of dobutamine stress echocardiography in aortic valve regurgitation and reduced left ventricular function

10.22541/au.163257712.20619146/v1 ◽

2021 ◽

Author(s):

Chihiro Saito ◽

Kotaro Arai ◽

Kyomi Ashihara ◽

Hiroshi Niinami ◽

Nobuhisa Hagiwara

Keyword(s):

Aortic Valve ◽

Stress Echocardiography ◽

Dobutamine Stress Echocardiography ◽

Dobutamine Stress ◽

Left Ventricular ◽

Valve Surgery ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Aortic Valve Surgery ◽

Ventricular Ejection Fraction

Objective: Predictors for post-operative reverse remodeling in patients with severe aortic regurgitation (AR) and reduced left ventricular ejection fraction (LVEF) are unknown. We performed low-dose dobutamine stress echocardiography (DSE) in patients with severe AR and reduced LVEF to evaluate the relationship between contractile reserve (CR) and reverse remodeling after surgery. Methods: In 31 patients with chronic severe AR and reduced LVEF (LVEF < 50%), we performed pre-operative DSE, assessed CR and examined whether changes in preoperative DSE were associated with improvement of post-operative LVEF after aortic valve surgery. Results: The pre-operative echocardiographic findings were as follows: left ventricular (LV) end-diastolic dimension: 67 ± 10 mm, LV end-systolic dimension: 52 ± 13 mm and LVEF: 42% ± 8%. All patients underwent aortic valve surgery. Patients with pre-operative LVEF of >45% exhibited a significant increase in LVEF; however, patients with pre-operative LVEF of <45% showed no significant change. When we examined the results of DSE performed in patients with pre-operative LVEF of <45%, ΔLVEF of ≥6% (with CR) during DSE was related to an improvement in post-operative LVEF; ΔLVEF of ≥6% during DSE predicted an improvement in post-operative LVEF, with a sensitivity and specificity of 80% and 85%, respectively. Conclusions: DSE may be a helpful tool for predicting post-operative reverse remodeling in patients with severe AR and moderately reduced LVEF.

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Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-022-01754-5 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Ming-Kui Zhang ◽

Li-Na Li ◽

Hui Xue ◽

Xiu-Jie Tang ◽

He Sun ◽

...

Keyword(s):

Aortic Valve ◽

Left Ventricle ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Left Ventricular ◽

Reverse Remodeling ◽

Left Ventricle Remodeling ◽

Lv Remodeling ◽

Chronic Aortic Regurgitation

Abstract Background Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) with a severe dilated left ventricle and dysfunction leads to left ventricle remodeling. But there are rarely reports on the left ventricle reverse remodeling (LVRR) after AVR. This study aimed to investigate the LVRR and outcomes in chronic AR patients with severe dilated left ventricle and dysfunction after AVR. Methods We retrospectively analyzed the clinical datum of chronic aortic regurgitation patients who underwent isolated AVR. The LVRR was defined as an increase in left ventricular ejection fraction (LVEF) at least 10 points or a follow-up LVEF ≥ 50%, and a decrease in the indexed left ventricular end-diastolic diameter of at least 10%, or an indexed left ventricular end-diastolic diameter ≤ 33 mm/m2. The changes in echocardiographic parameters after AVR, survival analysis, the predictors of major adverse cardiac events (MACE), the association between LVRR and MACE were analyzed. Results Sixty-nine patients with severe dilated left ventricle and dysfunction underwent isolated AVR. LV remodeling in 54 patients and no LV remodeling in 15 patients at 6–12 months follow-up. The preoperative left ventricular dimensions and volumes were larger, and the EF was lower in the LV no remodeling group than those in the LV remodeling group (all p < 0.05). The adverse LVRR was the predictor for MACE at follow-up. The mean follow-up period was 47.29 months (range 6 to 173 months). The rate of freedom from MACE was 94.44% at 5 years and 92.59% at 10 years in the remodeling group, 60% at 5 years, and 46.67% at 10 years in the no remodeling group. Conclusions The left ventricle remodeling after AVR was the important predictor for MACE. LV no remodeling may not be associated with benefits from AVR for chronic aortic regurgitation patients with severe dilated LV and dysfunction.

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