Cardiac Remodeling and Disease Progression in Patients With Repaired Coarctation of Aorta and Aortic Stenosis

Background: Valvulo-arterial impedance (Zva) is used for assessment of left ventricular (LV) global pressure load in patients with aortic stenosis (AS) and impaired arterial compliance. Because patients with repaired coarctation of aorta (COA) have impaired arterial compliance, we hypothesized that COA patients with greater than or equal to moderate AS (AS-COA group) will have higher Zva, symptomatic progression, and cardiovascular events, as compared to non-COA patients with similar AS severity (AS group). Methods: Propensity matching (1:1) of 71 AS-COA and 71 AS patients based on age, sex, body mass index, and aortic valve mean gradient (cohort 1). Of 172 patients, 117 patients (AS-COA [n=62]; AS [n=55]) underwent aortic valve replacement, cohort 2. Cohort 1 was used to assess the relationship between preoperative Zva, cardiac remodeling, and symptomatic progression, while cohort 2 was used to assess the relationship between postoperative Zva, LV mass index regression (reduction in LV mass index after aortic valve replacement), and cardiovascular events. Results: The AS-COA group had higher Zva (4.2±0.6 versus 3.5±0.4 mm Hg/mL·m 2 , P <0.001), more advanced cardiac remodeling, and higher 5-year incidence of symptomatic progression (85% versus 51%, P <0.001). Preoperative Zva was independently associated with cardiac remodeling (r=0.66, P <0.001) and symptomatic progression (hazard ratio, 1.06 [1.02–1.10], per mm Hg/mL·m 2 increase in Zva). The AS-COA group had higher postoperative Zva (3.3±0.5 versus 2.4±0.4 mm Hg/mL·m 2 , P <0.001), less robust LV mass index regression at 1-year post–aortic valve replacement, and higher 5-year incidence of cardiovascular events. Postoperative Zva was independently associated with LV mass index regression (r=−0.46, P <0.001) and cardiovascular events (hazard ratio, 1.06 [1.02–1.10], per mm Hg/mL·m 2 increase in Zva). Conclusions: Adults with AS-COA had higher LV global pressure load, cardiac remodeling, symptomatic progression, and cardiovascular events as compared to non-COA patients with similar severity of AS. Zva can identify patients at risk for adverse outcomes, and perhaps should be used for risk stratification with regards to timing of aortic valve replacement.

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SUN-P177: The Relationship between Nutritional Status and Postoperative Complications after Aortic Valve Replacement Due to Aortic Stenosis in Elderly Patients

Clinical Nutrition ◽

10.1016/s0261-5614(17)30451-x ◽

2017 ◽

Vol 36 ◽

pp. S119

Author(s):

E.W. Wernio ◽

S. Małgorzewicz ◽

D. Jagielak

Keyword(s):

Postoperative Complications ◽

Aortic Valve ◽

Aortic Stenosis ◽

Nutritional Status ◽

Aortic Valve Replacement ◽

Elderly Patients ◽

Valve Replacement ◽

The Relationship

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Sex and regional differences in myocardial plasticity in aortic stenosis are revealed by 3D model machine learning

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez166 ◽

2019 ◽

Cited By ~ 1

Author(s):

Anish N Bhuva ◽

Thomas A Treibel ◽

Antonio De Marvao ◽

Carlo Biffi ◽

Timothy J W Dawes ◽

...

Keyword(s):

Machine Learning ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Risk Stratification ◽

Valve Replacement ◽

Wall Thickness ◽

Left Ventricular ◽

Inferior Wall ◽

Lv Mass

Abstract Aims Left ventricular hypertrophy (LVH) in aortic stenosis (AS) varies widely before and after aortic valve replacement (AVR), and deeper phenotyping beyond traditional global measures may improve risk stratification. We hypothesized that machine learning derived 3D LV models may provide a more sensitive assessment of remodelling and sex-related differences in AS than conventional measurements. Methods and results One hundred and sixteen patients with severe, symptomatic AS (54% male, 70 ± 10 years) underwent cardiovascular magnetic resonance pre-AVR and 1 year post-AVR. Computational analysis produced co-registered 3D models of wall thickness, which were compared with 40 propensity-matched healthy controls. Preoperative regional wall thickness and post-operative percentage wall thickness regression were analysed, stratified by sex. AS hypertrophy and regression post-AVR was non-uniform—greatest in the septum with more pronounced changes in males than females (wall thickness regression: −13 ± 3.6 vs. −6 ± 1.9%, respectively, P < 0.05). Even patients without LVH (16% with normal indexed LV mass, 79% female) had greater septal and inferior wall thickness compared with controls (8.8 ± 1.6 vs. 6.6 ± 1.2 mm, P < 0.05), which regressed post-AVR. These differences were not detectable by global measures of remodelling. Changes to clinical parameters post-AVR were also greater in males: N-terminal pro-brain natriuretic peptide (NT-proBNP) [−37 (interquartile range −88 to −2) vs. −1 (−24 to 11) ng/L, P = 0.008], and systolic blood pressure (12.9 ± 23 vs. 2.1 ± 17 mmHg, P = 0.009), with changes in NT-proBNP correlating with percentage LV mass regression in males only (ß 0.32, P = 0.02). Conclusion In patients with severe AS, including those without overt LVH, LV remodelling is most plastic in the septum, and greater in males, both pre-AVR and post-AVR. Three-dimensional machine learning is more sensitive than conventional analysis to these changes, potentially enhancing risk stratification. Clinical trial registration Regression of myocardial fibrosis after aortic valve replacement (RELIEF-AS); NCT02174471. https://clinicaltrials.gov/ct2/show/NCT02174471.

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Epidemiological aspects of the aortic valve pathology

Vestnik of Russian military medical Academy ◽

10.17816/brmma75942 ◽

2021 ◽

Vol 23 (3) ◽

pp. 23-28

Author(s):

Alexander V. Gordienko ◽

Nizam N. Shikhverdiev

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Clinical Manifestations ◽

Military Medical Academy ◽

Medical Academy ◽

Valve Pathology ◽

The Military ◽

The Relationship

The dynamics of the structure of aortic valve pathology over the thirty-year (19912020) period of operation of the cardiac surgery hospital of the first department and the clinic of surgery for advanced training of doctors of the Military Medical Academy named after S.M. Kirov is evaluated. 849 cases of aortic valve replacement were retrospectively studied (626 (74%) men, 223 (26%) women). The average age of the patients was 51.8 9.7 years. It was established that the main causes of aortic valve damage were rheumocarditis, calcified aortic stenosis, infectious endocarditis and congenital heart disease in the form of a bicuspid aortic valve. A significant decrease in the incidence of rheumatism as a cause of aortic malformation was revealed from 36% in the period from 1991 to 2000 to 13% in the period from 2011 to 2020. The frequency of calcified aortic stenosis during this period, on the contrary, increased from 30% to 70%, respectively. At the same time, the relationship between the increase in life expectancy of the population of the Russian Federation and the frequency of occurrence of calcified aortic stenosis is traced. This is due to a long asymptomatic period that characterizes the natural course of this pathology, as a result of which the clinical manifestations of this pathology manifest, as a rule, only in old age. During the study period, an increase in the average age of patients who needed aortic valve replacement was also noted. If in the last decade of the twentieth century. it was 41.5 years, then in the period from 2011 to 2020, the average age of patients who needed aortic valve replacement increased to 61.5 years. Thus, over the past thirty years, there has been a significant change in the structure of the pathology of the aortic valve. Calcified aortic stenosis has become the most common cause of prosthetics of aortic malformation, against the background of a significant decrease in the frequency of rheumatic genesis of aortic valve damage.

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