Left ventricular mass index in aortic valve surgery: a new index for early valve replacement?☆

Abstract

Increased left ventricular mass index is associated with an in-hospital adverse outcome and a significantly higher in-hospital mortality in patients undergoing aortic valve replacement. Outcomes in asymptomatic patients could be improved before a clinically significant increase in left ventricular mass index. Further studies should be performed to determine the usefulness of this index in selecting patients for earlier aortic valve replacement.

Predictors and Prognostic Value of Myocardial Injury During Transcatheter Aortic Valve Implantation

“…Hypertrophied left ventricles are especially susceptible to subendocardial myocardial damage, because of the reduced myocardial capillary density and high intracavitary pressures, even in the absence of obstructive coronary artery disease. 36,37 During TAVI, reduced myocardial oxygen supply may result from temporary aortic valve occlusion during balloon valvuloplasty and from hypotension by rapid ventricular pacing, bradycardia due to cardiac conduction disorders, and theoretically distal embolization into the coronary (micro)circulation. Patent coronary arteries were verified with aortic angiography in all patients after prosthesis deployment, which excludes (partial) coronary obstruction as a cause of myocardial injury.…”

“…44 An increased left ventricular mass index was identified in our study as an independent predictor for 30-day mortality and cumulative 1-year mortality after TAVI, an expected finding in line with surgical aortic valve replacement. 36,45,46 The underlying mechanisms that can explain the relationship between myocardial injury and 30-day mortality after TAVI remain unclear. The extent of myocardial injury during TAVI is relatively small and diffuse and does not impair myocardial function or cause ventricular arrhythmias leading to sudden cardiac death.…”

Severe Aortic Stenosis and Myocardial Function

“…18,19 IBS could integrate conventional echo evaluation of LV function in two ways: (1) the cross-point of increase in IBS si over which degenerative myocardial alterations in LV hypertrophy could develop into CHF (see ROC), and (2) the initial functional CVI and IBSV alterations, which reflect the intrinsic myocardial contractility abnormalities. Both early impairment of IBS indexes, together with clinical findings (increasing dyspnea, inserting angina pectoris, or syncope) and Doppler evaluation of aortic stenosis hemodynamics, allow identification of the patients with CHF and aortic stenosis, separating them from those with cardiomyopathy and AS.…”

Association Between Renal Function, Diastolic Dysfunction, and Postoperative Atrial Fibrillation Following Cardiac Surgery

“…17, 18 According to this formula, LV hypertrophy (LVH) is defined as LVMI >131 g/m 2 in men and as >100 g/m 2 in women. 17, 18 Doppler echocardiography was performed to determine the early mitral inflow velocity (E), and tissue Doppler imaging evaluation was done to determine the medial mitral annulus velocity during passive filling (e'). 19, 20 Diastolic dysfunction was defined as an E/e' ratio >15, as previously described.…”