Regression of left ventricle hypertrophy in patients with critical aortic stenosis after aortic valve replacement

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Published: Jan 9, 2018
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“Regression of Left Ventricle Hypertrophy in Patients With Critical Aortic Stenosis After Aortic Valve Replacement”. Ukrainian Journal of Cardiology, no. 6, Jan. 2018, pp. 79-88, https://ucardioj.com.ua/index.php/UJC/article/view/104.
Issue
No. 6 (2017): Ukrainian Journal of Cardiology
Section
Heart diseases

Main Article Content

N. V. Ponych
Heart Institute of Healthcare Ministry of Ukraine, Kyiv, Ukraine Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Abstract

The aim – to determine the predictors of regression of left ventricular hypertrophy (LVH) in patients with critical aortic stenosis (AS) after aortic valve replacement (AVR).
Material and methods. In one-center study, the results of a prospective observation in 119 patients with AS sequentially examined before and 6–12 months after the AVR surgery were analyzed. Among them were 74 (62.2 %) men and 45 (37.8 %) women, median age 63 years (quartiles 56.5–72.0 years). All patients underwent clinical, laboratory and instrumental studies before the operation, including transthoracic echocardiography (TTE) and coronary angiography. Depending on the changes of the left ventricular myocardial mass index (IMM LV) 6–12 months after AVR, all patients were retrospectively divided into two groups: in 52 (43.7 %) patients, the relative decrease in the IMM LV was from 0 to 30 %, and in 67 (56.3 %) – more than 30 % (maximum – 63 %).
Results. Median relative decrease of IMM LV after AVR after 6–12 months was 32.31 % (quartiles 23–40 %). Patients with less dynamics of IMM LV were characterized by a greater frequency of concomitant hypertension, angina pectoris and a large number of hemodynamically significant stenoses of the coronary arteries. The group of patients with large LVH regression was characterized by larger volume of the left atrium, larger IMM LV, lower initial left ventricular ejection fraction (LVEF), higher Tei index, lower MAPSE and systolic wave s, longer corrected QT interval. According to the multivariate analysis, the predictors of more severe LVH regression were the initial IMM LV, LVEF, mitral regurgitation, the duration of the corrected QT interval, and the absence of concomitant multivessel lesions of the coronary arteries. The accuracy of the prediction of the group with weaker dynamics of the IMM LV was 73.3 %, with a pronounced LVH regression – 79.7 %, the overall accuracy of the model was 76.9 %.
Conclusions. The severity of the IMM LV decrease is one of the most important indicators of the long-term effect of AVR in patients with critical AS. Output LVM, LVEF, mitral regurgitation, the duration of the corrected QT interval, and the absence of concomitant multivessel coronary artery lesions are independent predictors of a more favorable dynamics of IMM LV 6–12 months after AVR.

Article Details

Keywords:

aortic stenosis, aortic valve replacement, left ventricular hypertrophy, regression, predictors

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