Relevance of residual left ventricular hypertrophy after surgery for isolated aortic stenosis
Relevance of residual left ventricular hypertrophy after surgery for isolated aortic stenosis
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DOI：
10.1093/ejcts/ezv240
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发表时间：
2016-03-01
影响因子：
3.4
通讯作者：
Leite-Moreira, Adelino
中科院分区：
文献类型：
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作者：
Gavina, Cristina;Falcao-Pires, Ines;Leite-Moreira, Adelino
术后持续性左心室肥厚是常见的，但其临床相关性是有争议的。我们对132例重度主动脉瓣狭窄(AS)患者行主动脉瓣置换术(AVR)前后的临床和超声心动图参数进行了分析，以评估残余LV肥厚(LVH)是否与主动脉瓣置换术(AVR)后的临床结果相关。平均随访时间为6.0+/-1.5年。临床终点为全因死亡和全因死亡与非致死性心血管住院合并AS。在AVR时，随机抽取56名患者进行心肌活组织检查，检测胶原体积分数(CVF)。AVR后44%的患者存在残余的左心室肥厚。残留左心室肥厚的患者年龄较大，多为女性，且有高血压(HT)。术前左心室重量指数(LVMI)、E/e‘和左房容量指数升高，收缩期环峰值速度降低。女性、高血压、左心室重量指数和E/E‘是持续性左心室肥厚的独立预测因素。残余左心室肥厚患者手术时CVF值较高(20.0±14.6vs13.2+/-11.5%，P=0.027)。残留左心室肥厚患者全因死亡和非致死性心血管住院的风险较高[OR2.89(95%CI1.12~7.44)；P=0.035]，但全原因死亡率差异无统计学意义。残留的左心室肥厚在女性中与较差的预后相关，但在男性中不相关。AVR后残留的左心室肥厚是常见的，并与较差的预后相关，特别是在女性。此外，高血压、较高的基础LVM和更严重的舒张期功能障碍可以帮助识别LVM不完全正常化的风险。
Persistent left ventricular (LV) hypertrophy after surgery is frequent, but its clinical relevance is controversial. We evaluated if residual LV hypertrophy (LVH) is associated with clinical outcomes after aortic valve replacement (AVR) for severe aortic stenosis (AS).We analysed clinical and echocardiographic parameters before and after AVR, in a prospective cohort of 132 patients with severe AS. The mean follow-up was 6.0 +/- 1.5 years. Clinical endpoints were all-cause death and combination of as in all-cause death and non-fatal cardiovascular hospitalization. At AVR, myocardial biopsies for collagen volume fraction (CVF) evaluation were done in 56 random patients.Residual LVH was present in 44% of patients after AVR. Patients with residual LVH were older, more frequently women and had hypertension (HT). Preoperatively, they had higher LV mass indices (LVMI), higher E/e' and left atrial volume indices, as well as lower peak systolic annular velocity. Female gender, HT, LVMI and E/e' were independent predictors of persistent LVH. CVF at the time of surgery was higher in those with residual LVH (20.0 +/- 14.6 vs 13.2 +/- 11.5%, P = 0.027). The risk of all-cause death and non-fatal cardiovascular hospitalization was higher in patients with residual LVH [OR 2.89 (95% CI 1.12-7.44); P = 0.035], but there were no differences in all-cause mortality. Residual LVH was associated with a worse outcome in women but not in men.Residual LVH after AVR is common and is associated with worse prognosis, particularly in women. In addition, HT, higher baseline LVM and worse diastolic dysfunction can help to identify patients at risk for incomplete normalization of LVM.