Early Regression of Left Ventricular Hypertrophy After Aortic Valve Replacement by the Ross Procedure Detected by Cine MRI

Djavidani, Behrus; Schmid, Franz X.; Keyser, Andreas; Butz, B.; Seitz, Johannes; Luchner, Andreas; Debl, Kurt; Feuerbach, Stefan; Nitz, Wolfgang R.

doi:10.1081/jcmr-120027799

Cited by 11 publications

(8 citation statements)

References 21 publications

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“…Two clinical studies investigated LVM regression after AVR. 12, 13 Christakis et al 12 found a significant decrease in LVM of Ϸ14% in Ͻ5 days after surgery, which is very similar to our own investigation. However, they did not differentiate between sexes.…”

Section: S26supporting

confidence: 79%

“…However, they did not differentiate between sexes. Djavidani et al 13 showed after AVR a 13% decrease in LVM in the early postoperative period and a further 16% in the late postoperative period. Because only 1 female patient was included in this study, they also did not differentiate between women and men.…”

Section: S26mentioning

confidence: 99%

“…The late follow-up period has been studied in detail, but very few studies analyzed the early time course of regression. 12,13 In addition, sex differences in the regression of myocardial hypertrophy and fibrosis after AVR have not yet been analyzed. This is astonishing, because sex differences in the manifestation of LVH before surgery are well accepted.…”

mentioning

confidence: 99%

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Regression of Myocardial Hypertrophy After Aortic Valve Replacement

Petrov

Regitz‐Zagrosek²,

Lehmkuhl³

et al. 2010

Circulation

198

145

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Background-In patients with aortic stenosis, pressure overload induces cardiac hypertrophy and fibrosis. Female sex and estrogens influence cardiac remodeling and fibrosis in animal models and in men. Sex differences and their molecular mechanisms in hypertrophy regression after aortic valve replacement have not yet been studied. Methods and Results-We prospectively obtained preoperative and early postoperative echocardiography in 92 patients, 53 women and 39 men, undergoing aortic valve replacement for isolated aortic stenosis. We analyzed in a subgroup of 10 patients matrix gene expression in left ventricular (LV) biopsies. In addition, we determined the effect of 17␤-estradiol on collagen synthesis in isolated rat cardiac fibroblasts. Preoperatively, women and men had similar ejection fraction. Similar percentages of women and men had increased LV diameters (37% and 38%). Women more frequently exhibited LV hypertrophy than men (women: 86%; men: 56%; PϽ0.01). Postoperatively, increased LV diameters persisted in 34% of men but only in 12% of women (PϽ0.023). LV hypertrophy reversed more frequently in women than in men, leading to a similar prevalence of LV hypertrophy after surgery (women: 45%; men: 36%). In surgical biopsies, men had significantly higher collagen I and III and matrix metalloproteinase 2 gene expression than women. In isolated rat cardiac fibroblasts, 17␤-estradiol significantly increased collagen I and III gene expressions in male cells but decreased it in female cells. Conclusion-Women

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Section: S26supporting

confidence: 79%

Section: S26mentioning

confidence: 99%

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Regression of Myocardial Hypertrophy After Aortic Valve Replacement

Petrov

Regitz‐Zagrosek²,

Lehmkuhl³

et al. 2010

Circulation

198

145

View full text Add to dashboard Cite

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“…However, the long-term data tracking the surgically induced beneficial effects of afterload reduction on reverse LV remodeling are available only in limited fashion. Moreover, the majority of the available data exists in echocardiographic literature, is pertinent to remodeling concepts is available short term [6,7], but only in limited fashion beyond one year [8-12]. …”

Section: Introductionmentioning

confidence: 99%

LV reverse remodeling imparted by aortic valve replacement for severe aortic stenosis; is it durable? A cardiovascular MRI study sponsored by the American Heart Association

Biederman

Magovern

Grant

et al. 2011

J Cardiothorac Surg

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BackgroundIn patients with severe aortic stenosis (AS), long-term data tracking surgically induced effects of afterload reduction on reverse LV remodeling are not available. Echocardiographic data is available short term, but in limited fashion beyond one year. Cardiovascular MRI (CMR) offers the ability to serially track changes in LV metrics with small numbers due to its inherent high spatial resolution and low variability.HypothesisWe hypothesize that changes in LV structure and function following aortic valve replacement (AVR) are detectable by CMR and once triggered by AVR, continue for an extended period.MethodsTweny-four patients of which ten (67 ± 12 years, 6 female) with severe, but compensated AS underwent CMR pre-AVR, 6 months, 1 year and up to 4 years post-AVR. 3D LV mass index, volumetrics, LV geometry, and EF were measured.ResultsAll patients survived AVR and underwent CMR 4 serial CMR's. LVMI markedly decreased by 6 months (157 ± 42 to 134 ± 32 g/m2, p < 0.005) and continued trending downwards through 4 years (127 ± 32 g/m2). Similarly, EF increased pre to post-AVR (55 ± 22 to 65 ± 11%,(p < 0.05)) and continued trending upwards, remaining stable through years 1-4 (66 ± 11 vs. 65 ± 9%). LVEDVI, initially high pre-AVR, decreased post-AVR (83 ± 30 to 68 ± 11 ml/m2, p < 0.05) trending even lower by year 4 (66 ± 10 ml/m2). LV stroke volume increased rapidly from pre to post-AVR (40 ± 11 to 44 ± 7 ml, p < 0.05) continuing to increase non-significantly through 4 years (49 ± 14 ml) with these LV metrics paralleling improvements in NYHA. However, LVmass/volume, a 3D measure of LV geometry, remained unchanged over 4 years.ConclusionAfter initial beneficial effects imparted by AVR in severe AS patients, there are, as expected, marked improvements in LV reverse remodeling. Via CMR, surgically induced benefits to LV structure and function are durable and, unexpectedly express continued, albeit markedly incomplete improvement through 4 years post-AVR concordant with sustained improved clinical status. This supports down-regulation of both mRNA and MMP activity acutely with robust suppression long term.

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“…MRI is a highly sensitive diagnostic tool to assess LV mass and volume 8,9 . In addition, because of its high reproducibility, changes in mass and volume are easily identified.…”

mentioning

confidence: 99%