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ȣ - 510114 191 |
| Preoperative determinants of left ventricular mass regression after aortic valve replacement surgery in severe aortic stenosis |
| 성균관의과대학 삼성서울병원 심장혈관센터 ¹순환기내과, ²흉부외과, ³분당 서울대병원 흉부외과 |
| 양지현¹, 최진오¹, 온영근¹, 권현철¹, 김준수¹, 김덕경¹, 이상훈¹, 성기익², 박계현³, 박표원², 박승우¹ |
Backgrounds: Left ventricular (LV) mass index (LVMI) is associated with mortality and morbidity after aortic valve replacement (AVR) in patients with aortic stenosis (AS). However, there are some patients with normal LVMI in the presence of severe AS and their clinical characteristics related to LV mass regression after AVR are not fully understood. We sought to evaluate the preoperative determinants of LV mass regression after AVR in patients with severe AS.
Methods: A total of 114 patients with severe AS were evaluated with echocardiography pre- and postoperatively (9 ± 3 months after AVR). Clinical and echocardiographic parameters were measured and compared among groups according to pre- and postoperative LVMI.
Results: Mean preoperative LVMI was 148 ± 40 g/m2, which decreased to 109 ± 28 g/m2 postoperatively. There were 18 patients with low (≤ 110 g/m2) pre- and postoperative LVMI (Group I), 42 with high (> 110 g/m2) preoperative and low postoperative LVMI (Group II), and 55 with high pre- and postoperative LVMI (Group III) (see Table). In multivariate analysis, age (p=0.001), preoperative relative wall thickness (p=0.004) and left atrial dimension (p=0.016) revealed significant relationship with postoperative LVMI in order.
Conclusions: Preoperative systolic and diastolic function of LV, and chronicity of the disease might be the important factors of LV mass regression after AVR in patients with severe AS.
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Table. Clinical
and echocardiographic characteristics
|
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Group I (N=18) |
Group II (N=45) |
Group III (N=51) |
p-value* |
|
Age, year |
55.2
± 13.4 †
|
60.9
± 7.5 ‡ |
65.3
± 9.5 § |
0.001 |
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Male, n (%) |
8 (44.4) |
32 (71.1) |
32 (62.7) |
0.145 |
|
Preoperative LVMI, g/m2 |
89.1
± 15.9 †
|
142.5
± 25.2 ‡ |
173.5
± 33.6 § |
0<0.0010 |
|
Aortic valve area, cm2 |
0.74 ± 0.30 |
0.68 ± 0.17 |
0.62±
0.13 § |
0.032 |
|
Relative wall thickness |
0.36
± 0.08 † |
0.43 ± 0.08 |
0.46
± 0.10§ |
<0.001 |
|
LV EF, % |
65.3 ± 6.3 |
62.1
± 10.8 ‡ |
55.1
± 12.7 § |
0.001 |
|
LA dimension, mm |
39.4 ± 8.8 |
40.6
± 7.1 ‡ |
44.6
± 6.3 § |
0.005 |
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Mitral annulus E' velocity, cm/s
|
5.3 ± 1.8 |
5.3
± 1.2 ‡ |
4.5 ± 1.2 |
0.028 |
* by 1-way ANOVA or Chi-square test; † p <0.05 vs group II; ‡ p
<0.05 vs group III; § p <0.05 vs group I via post hoc analysis with
LSD
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