Time course of regression of left ventricular hypertrophy after aortic valve replacement.

Abstract

To assess the time course and extent of regression of myocardial hypertrophy after removal of the inciting hemodynamic stress, 21 patients with either aortic stenosis or aortic insufficiency were studied preoperatively, after an intermediate period (1.6 + 0.5 years), and late (8.1 + 2.9 years) after aortic valve replacement, and results were compared with those in 11 control patients. After aortic valve replacement there was significant hemodynamic improvement, with a fall in the left ventricular end-diastolic volume index (164 + 73 to 105 + 35 ml/m2, p < .01), a fall in left heart filling pressure (19 + 9 to 12 + 5 mm Hg, p < .01), and maintenance of the cardiac index (3.3 + 0.8 to 3.5 ± 0.8 liters/min/m2, NS) and left ventricular ejection fraction (60 ± 13% to 64 ± 10%, NS). By the late study the cardiac index (4.0 ± 0.6 liters/min/m2, p < .01) and left ventricular ejection fraction (66 ± 15%, p < .05) had further increased and were significantly greater than before surgery. For the group as a whole, the left ventricular muscle mass index fell 31% after surgery by the time of the intermediate postoperative study (174 ± 38 vs 120 ± 29 g/m2, p < .01), and a further 13% from the intermediate to the late study (105 ± 32 g/m2, p < .05). At the preoperative study left ventricular muscle mass index was greatest in those patients with aortic insufficiency (191 ± 36 g/m2), and greater in those with aortic stenosis (158 ± 33 g/m2) than in control subjects (85 ± 9 g/m2, p < .05). At the intermediate postoperative study left ventricular muscle mass index remained significantly higher in both those with preoperative aortic insufficiency (128 ± 29 g/m2) and those with stenosis (114 ± 27 g/m2) than in the control subjects (p < .01). By the time of the late postoperative study there were no longer any significant differences in left ventricular muscle mass index. Thus, the regression of myocardial hypertrophy is a process that occurs over many years after correction of the primary hemodynamic abnormality. As this process of myocardial remodeling occurs, continued improvement in cardiac function may occur, and the improvement occurring between the intermediate and late postoperative studies at a slight but constant afterload excess (inherent in the relative stenosis of the aortic prosthesis) suggests that the hypertrophied myocardium is operating at a reduced level compared with normal myocardium. Circulation 77, No. 6, 1345No. 6, -1355No. 6, , 1988 LEFT VENTRICULAR pressure and volume overloads in response to aortic valve stenosis and aortic valve insufficiency lead to a marked hypertrophic response of the myocardium, likely as an adaptative response to normalize the increased wall stress accompanying these states.' While this allows for maintenance

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

“…17,25 This complicates the finding that LV mass regression is greater after SAVR given the significantly lower rate of PPM in TAVR and higher survival after CoreValve implantation compared to SAVR. 9 The majority of LV mass regression after AVR (10% to 30%) is complete by 1 year, but this process of reverse remodeling continues for several years after AVR, 26,27 despite the presence of a constant, albeit smaller, pressure gradient with the prosthesis. Available data, although limited, suggest that residual LV hypertrophy has a negative impact on long-term survival after AVR in patients with severe aortic stenosis, 25,28 but other findings indicate that only a high preoperative LV mass, and not the extent of LV mass regression, determine clinical outcomes.…”

Functional Changes in Coronary Microcirculation After Valve Replacement in Patients With Aortic Stenosis

“…7 This is associated with an improvement in coronary blood flow in patients after AVR measured both invasively 8 and noninvasively. 9 However, the effect of AVR on microcirculatory dysfunction and the role that hemodynamic changes and LVH regression play remain unclear.…”

Left ventricular function after correction of chronic aortic regurgitation.

“…While some investigators report that regression of hypertrophy is complete before the end of the first postoperative year,' 9'16 this view has recently been challenged. 6 '7 The report by Monrad and associates6 on regression of hypertrophy after valve replacement in patients with aortic regurgitation supports the view that the process of myocardial remodeling may continue for many years. Data that were collected an average of 1.6 and 8.1 years after valve replacement in 11 patients with aortic stenosis and in 10 patients with aortic regurgitation indicated in some patients a significant further reduction in left ventricular mass at the time of the late study.…”