Pre- and Postoperative Predictors of Long-Term Prognosis After Aortic Valve Replacement for Severe Chronic Aortic Regurgitation

Amano, Masashi; Izumi, Chisato; Imamura, Sari; Onishi, Nobuyuki; Sakamoto, Jiro; Tamaki, Yodo; Enomoto, Soichiro; Miyake, Makoto; Tamura, Toshihiro; Kondo, Hirokazu; Kaitani, Kazuaki; Yamanaka, Kazuhiro; Nakagawa, Yoshihisa

doi:10.1253/circj.cj-16-0782

Cited by 22 publications

(24 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Numerous studies involving >1000 patients have consistently shown that measures of LVEF and LVESD or LVESV are associated with the development of symptoms or death in initially asymptomatic patients with severe AR . Moreover, in symptomatic patients undergoing AVR, preoperative LVEF, and LV dimensions are significant determinants of survival after surgery . It is therefore crucial to accurately identify the change in LV dimensions during follow‐up of patients with AR.…”

Section: Discussionmentioning

confidence: 99%

“…A postoperative reduction in LV end‐systolic diameter (LVESD) is associated with improvement in LVEF and New York Heart Association (NYHA) functional class . Furthermore, a more recent study demonstrated that LV end‐systolic volume indexed (LVESVi) was a predictor of clinical outcome …”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Furthermore, a more recent study demonstrated that LV end-systolic volume indexed (LVESVi) was a predictor of clinical outcome. 7 Despite widespread use of LV volumetric measures, no study has compared linear to volumetric dimensions in the assessment of LV remodeling in patients with severe AR. The objective of our study therefore was to determine whether LV volumes could better define LV reverse remodeling when compared to a LV diameters in patients with isolated severe AR receiving AVR.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of left ventricular reverse remodeling in patients with severe aortic regurgitation undergoing aortic valve replacement: Comparison between diameters and volumes

et al. 2017

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of left ventricular reverse remodeling in patients with severe aortic regurgitation undergoing aortic valve replacement: Comparison between diameters and volumes

et al. 2017

View full text Add to dashboard Cite

show abstract

“…5 Postoperative LVEF is an important determinant of long-term prognosis in patients with severe chronic AR. 6 Therefore, it is valuable to identify the parameters predicting improvement or worsening of the LVEF after surgery. In previous studies, myocardial fibrosis was associated with poor postoperative LV systolic function in severe AR.…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, in some patients, LVEF does not improve after surgery 5 . Postoperative LVEF is an important determinant of long‐term prognosis in patients with severe chronic AR 6 . Therefore, it is valuable to identify the parameters predicting improvement or worsening of the LVEF after surgery.…”

Section: Introductionmentioning

confidence: 99%

Presence of fragmented QRS is associated with left ventricular systolic dysfunction after surgery in patients with severe aortic regurgitation

et al. 2021

View full text Add to dashboard Cite

Background and Aim of the study: Chronic severe aortic regurgitation (AR) is associated with progressive accumulation of interstitial fibrosis and disruption of myocardial structure. After aortic valve replacement (AVR), the negative remodeling process reverses, and left ventricular ejection fraction (LVEF) improves but not in all patients. In this study, we aimed to investigate the association of fragmented QRS (F-QRS), which is a possible marker of myocardial fibrosis, with postoperative left ventricular (LV) systolic dysfunction. Methods: A total of 147 consecutive patients with AVR were included in this study. F-QRS was identified by the presence of various RSR' patterns (QRS duration <120 ms) such as additional R wave (R prime)or notching of the R or S wave in at least two consecutive leads. Patients were compared in two groups based on the presence or absence of F-QRS. A logistic regression model was used to determine independent predictors of postoperative LV systolic dysfunction (LVEF <50%). Results: Patients with F-QRS were associated with poor recovery of LV systolic function after AVR compared to the patients without F-QRS, regardless of preoperative LVEF (p = .008). F-QRS was found to be an independent predictor of postoperative LV systolic dysfunction (LVEF <50%). Lower preoperative LVEF and increased LV end diastolic diameter index were also found as independent risk factors for postoperative LV systolic dysfunction. Conclusions: As a possible marker of myocardial fibrosis, F-QRS was associated with postoperative LV systolic dysfunction. Therefore, as a simple and convenient clinical parameter, F-QRS may be used to predict poor recovery of LVEF after AVR.

show abstract

Analysis of Left Ventricular Indexes and Mortality Among Asian Adults With Hemodynamically Significant Chronic Aortic Regurgitation

Yang

Lee

et al. 2023

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

ImportanceChronic hemodynamically significant aortic regurgitation (AR) is associated with excess risk of death, yet data for Asian patients are lacking, and whether Asian patients can abide by Western guidelines as to when aortic valve surgery should be performed is unknown.ObjectiveTo assess AR presentation and cutoffs of left ventricular ejection fraction (LVEF), LV end-systolic dimension index (LVESDi), and LV end-systolic volume index (LVESVi) that are associated with risk of death in Asian patients with AR.Design, Setting, and ParticipantsThis retrospective cohort study included consecutive patients with chronic, moderately severe to severe AR from 3 tertiary referral centers (2 in Japan and 1 in Taiwan) from June 11, 2008, through November 19, 2020, with follow-up through November 11, 2021.ExposuresAortic regurgitation severity, graded by a comprehensive integrated approach.Main Outcomes and MeasuresThe primary outcome was the association between volume-derived LVEF, LVESDi, and LVESVi and all-cause death (ACD). The secondary outcome was the association of these LV indexes with cardiovascular death (CVD). Clinical and echocardiographic data were analyzed retrospectively. A de novo disk-summation method was used to derive LV volumes and volume-derived LVEF.ResultsOf 1259 patients (mean [SD] age, 64 [17] years; 934 [74%] male), 515 (41%) were Japanese and 744 (59%) were Taiwanese. The median follow-up was 4.1 years (IQR, 1.56-7.24 years). The mean (SD) body surface area was 1.67 (0.21) m2; LVEF, 55% (11%); LVESDi, 24.7 (5.7) mm/m2; LVESVi, 50.1 (28.0) mL/m2; and indexed mid–ascending aorta size, 24.7 (5.5) mm/m2. Aortic valve surgery occurred in 483 patients (38%); 240 patients (19%) died during follow-up. Overall mean (SD) 8-year survival was 74% (2%). Separate multivariate models adjusted for covariates demonstrated independent associations of LVEF, LVESDi, and LVESVi with ACD (LVEF: hazard ratio [HR] per 10%, 0.80; 95% CI, 0.70-0.92; P = .002; LVESDi: HR, 1.04; 95% CI, 1.01-1.06; P = .002; LVESVi: HR per 10 mL/m2, 1.11; 95% CI, 1.05-1.17; P &lt; .001) and CVD (LVEF: HR per 10%, 0.69; 95% CI, 0.56-0.85; P &lt; .001; LVESDi: HR, 1.05; 95% CI, 1.01-1.09; P = .01; LVESVi per 10 mL/m2: HR, 1.15; 95% CI, 1.06-1.24; P &lt; .001). In the total cohort, spline curves showed that mortality started to increase for an LVEF of 53% or less, LVESDi of 22 mm/m2 or greater, and LVESVi of 46 mL/m2 or greater for both ACD and CVD. Early surgery was beneficial in 3 strata of LVESDi (&lt;20, 20 to &lt;25, and ≥25 mm/m2) and 2 strata of LVESVi (&lt;46 and ≥46 mL/m2).Conclusions and RelevanceThis multicenter cohort study of Asian patients with hemodynamically significant AR found cutoff values of LVEF, LVESDi, and LVESVi that were associated with increased risk of death. These findings suggest that Western guidelines seem applicable in Asian patients and, most importantly, that indexed LV parameters with a lower cutoff could be used in discriminating patients with excess mortality risk.

show abstract

Pre- and Postoperative Predictors of Long-Term Prognosis After Aortic Valve Replacement for Severe Chronic Aortic Regurgitation

Cited by 22 publications

References 29 publications

Evaluation of left ventricular reverse remodeling in patients with severe aortic regurgitation undergoing aortic valve replacement: Comparison between diameters and volumes

Evaluation of left ventricular reverse remodeling in patients with severe aortic regurgitation undergoing aortic valve replacement: Comparison between diameters and volumes

Presence of fragmented QRS is associated with left ventricular systolic dysfunction after surgery in patients with severe aortic regurgitation

Analysis of Left Ventricular Indexes and Mortality Among Asian Adults With Hemodynamically Significant Chronic Aortic Regurgitation

Contact Info

Product

Resources

About