Left Ventricular Diastolic Function After Aortic Valve Replacement for Chronic Aortic Regurgitation

Ma, Wenrui; Zhang, Wei; Shi, Wei; Kong, Ye; Ma, Xinyu

doi:10.1016/j.athoracsur.2018.03.034

Cited by 15 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, LAScd added significantly to the prediction, suggesting that LAScd has additive prognostic value for patients with AR. A high prevalence of DD in patients with severe AR, and its adverse impact on postoperative cardiac function, has been reported previously [40]. In our study, moderate or advanced DD was found at baseline in one-third of the patients with AR.…”

Section: Systolic LV Functionsupporting

confidence: 82%

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Jenner

Ilami

Petrini

et al. 2021

Cardiovasc Ultrasound

View full text Add to dashboard Cite

Background The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed the structural and functional effects of severe AR on LV and left atrium before and after aortic valve replacement. Methods Patients with severe AR scheduled for aortic valve replacement (n = 65) underwent two- and three-dimensional echocardiography, including left atrial strain imaging, before and 1 year after surgery. A control group was selected, and comprised patients undergoing surgery for thoracic aortic aneurysm without aortic valve replacement (n = 20). Logistic regression analysis was used to assess predictors of impaired left ventricular functional and structural recovery, defined as a composite variable of diastolic dysfunction grade ≥ 2, EF < 50%, or left ventricular end-diastolic volume index above the gender-specific normal range. Results Diastolic dysfunction was present in 32% of patients with AR at baseline. Diastolic LV function indices and left atrial strain improved, and both left atrial and LV volumes decreased in the AR group following aortic valve replacement. Preoperative left atrial strain during the conduit phase added to left ventricular end-systolic volume index for the prediction of impaired LV functional and structural recovery after aortic valve replacement (model p < 0.001, accuracy 70%; addition of left atrial strain during the conduit phase to end-systolic volume index p = 0.006). Conclusions One-third of patients with severe AR had signs of diastolic dysfunction. Aortic valve surgery reduced LV and left atrial volumes and improved diastolic indices. Left atrial strain during the conduit phase added to the well-established left ventricular end-diastolic dimension for the prediction of impaired left ventricular functional and structural recovery at follow-up. However, long-term follow-up studies with hard endpoints are needed to assess the value of left atrial strain as predictor of myocardial recovery in aortic regurgitation.

show abstract

Section: Systolic LV Functionsupporting

confidence: 82%

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Jenner

Ilami

Petrini

et al. 2021

Cardiovasc Ultrasound

View full text Add to dashboard Cite

show abstract

“…Previous studies have analyzed the role of the diastolic function in sAR undergoing aortic valve replacement. Ma et al described that LV diastolic disfunction, analyzed by the integration of 2 echocardiographic parameters (LA volume index and E/e' ratio) is highly prevalent in patients undergoing aortic valve replacement and might improve after surgery [11]. In a similar way, Cayli et al [12] reported that diastolic function is a reliable parameter in predicting outcomes in patients with sAR and LV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Diastolic Function Parameters In Significant Aortic Regurgitation. The Role of The Left Atrial Strain

García-Martín

Sequeiros

Gómez

et al. 2022

Preprint

View full text Add to dashboard Cite

AimsThe management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. Prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. In particular, left atrial (LA) function has been shown to be an important determinant of morbimortality. The purpose of this study was to analyze the prognostic significance of diastolic function in asymptomatic patients with sAR.Methods and resultsA total of 126 patients with asymptomatic sAR were included. Conventional echocardiographic systolic and diastolic function parameters were assessed. LA and left ventricular (LV) auto-strain analysis was performed in a subgroup of 57 patients. During a mean follow up of 33±19 months, 25(19,8%) patients reached the combined end-point. Univariate analysis showed that LV volumes, LV ejection fraction (LVEF), LV-GLS, E wave, E/e’ ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events. Multivariate model-1 that tested all classical echocardiographic variables statistically significant in the univariate model showed that LVEDV [HR=1,02;95% CI:1,01-1,03;(p<0,001)] and E/e’ ratio [HR=1,12;95% CI:1,03-1,23;(p=0,01)] were significant predictors of events. In the subgroup of patients with auto-strain analyzed, a multivariate model-2 including the previous significant variables for the first model as well as LASr, showed that LVEDV [HR=1,05;95% CI:1,01-1,08;(p=0,016)] and LASr [HR=0,8;95% CI:0,65-0,98;(p<0,035)] were the most significant predictors of cardiovascular events.ConclusionsIn this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LASr played a strong independent predictor role.

show abstract

“…The details of surgical procedures were reported in previous studies. 7,8 Invasive approaches included sternotomy (n = 871, 89.1%), supra-sternotomy (n = 79, 8.1%) and minimally invasive right thoracotomy (n = 28, 2.9%). The left ventricle was routinely vented via right superior pulmonary vein.…”

Section: Operative Proceduresmentioning

confidence: 99%

Rhythm outcomes after aortic valve surgery: Treatment and evolution of new‐onset atrial fibrillation

Xiang

Shan

et al. 2021

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

Background: The impact of new-onset atrial fibrillation (AF) after aortic valve (AV) surgery on mid-and long-term outcomes is under debate. Here, we sought to follow up heart rhythms after AV surgery, and to evaluate the mid-term prognosis and effectiveness of treatment for patients with new-onset AF.Methods: This single-center cohort study included 978 consecutive patients (median age, 59 years; male, 68.5%) who underwent surgical AV procedures between 2017 and 2018. All patients with postoperative new-onset AF were treated with Class III antiarrhythmic drugs with or without electrical cardioversion (rhythm control). Status of survival, stroke, and rhythm outcomes were collected and compared between patients with and without new-onset AF.Results: New-onset AF was detected in 256 (26.2%) patients. For them, postoperative survival was comparable with those without new-onset AF (1-year: 96.1% vs. 99.3%; adjusted P = .30), but rate of stroke was significantly higher (1-year: 4.0% vs. 2.2%; adjusted P = .020). With rhythm control management, the 3-month and 1-year rates of paroxysmal or persistent AF between patients with and without newonset AF were 5.1% versus 1.3% and 7.5% versus 2.1%, respectively (both P < .001).Multivariate models showed that advanced age, impaired ejection fraction, newonset AF and discontinuation of beta-blockers were predictors of AF at 1 year. Conclusions:In most cases, new-onset AF after AV surgery could be effectively converted and suppressed by rhythm control therapy. Nevertheless, new-onset AF predisposed patients to higher risks of stroke and AF within 1 year, for whom prophylactic procedures and continuous beta-blockers could be beneficial.

show abstract

Left Ventricular Diastolic Function After Aortic Valve Replacement for Chronic Aortic Regurgitation

Abstract: In patients with chronic severe aortic regurgitation, left ventricular diastolic dysfunction is highly prevalent and might show gradual improvement after aortic valve replacement. However, such improvement could be hindered by an excessively dilated left ventricle during surgery.

Cited by 15 publications

References 20 publications

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Prognostic Value of Diastolic Function Parameters In Significant Aortic Regurgitation. The Role of The Left Atrial Strain

Rhythm outcomes after aortic valve surgery: Treatment and evolution of new‐onset atrial fibrillation

Contact Info

Product

Resources

About