The impact of global left ventricular afterload on left ventricular reverse remodeling after aortic valve replacement

Abstract

The postoperative Zva was significantly associated with LV mass regression after AVR. Maintaining low global LV afterload following AVR may enhance LV reverse remodeling.

Mass Regression after Aortic Valve Replacement in Aortic Stenosis: A Comparison between "Appropriate" and "Inappropriate" Left Ventricular Hypertrophy

“…Persistence of LV hypertrophy after AVR has multiple causes and may be due to a combination of patient-specific factors (such hypertension, Zva, diabetes, gender, obesity and other biological factors), fluid dynamics of the prosthesis and irreversible alterations in the myocardium. Hypertension is one of the most frequent factor that may be responsible for the persistence of LV hypertrophy [6] along with the high stiffness of the vascular system, resulting in a high arterial impedance or Zva [37]. These two conditions hamper LV mass regression both pre-operatively, with the deposition of irreversible fibrosis [11,20,23], and post-operatively if the hypertension is not adequately treated or a high LV impedance persists [6,36].…”

“…Apparently, this was not the case in our study, because both hypertension incidence and the level of the Zva and arterial compliance were similar in the two groups. Gender is known to influence LV remodeling in AS, since a higher mass, fibrosis deposition and possibly structurally irreversible alteration are more likely findings in males than in females [37]. In addition, angiotensin-renin system may modulate the degree of LV hypertrophy differently in male and in female patients [25].…”

Opening/closing pattern of Trifecta and Freestyle valves versus native aortic valve: Are stentless valves more physiologic than a stented valve?

“…In this regard, as reported in Table , aortic compliance proved to be greater in the Control group than in the two bioprosthesis groups. Previous studies have shown the importance of afterload on bioprosthetic valve hemodynamics …”

Global left ventricular afterload matters in left ventricular reverse remodeling after aortic valve replacement

“…Valvuloarterial impedance (Zva) is an echocardiographic derived measure of global LV afterload, and is calculated using the formula, Zva (mmHg/ml/m 2 ) = (systolic blood pressure + mean transvalvular pressure gradient)/stroke volume index [3]. We have shown that Zva is a significant predictor of LV reverse remodeling after AVR, as opposed to traditional parameters of prosthetic valve function including transvalvular pressure gradients and prosthetic valve EOA [4].…”