Reversal of left ventricular mass and global longitudinal strain in patients with severe aortic valve stenosis at three-month follow-up after aortic valve surgery replacement

    Authors

    Keywords

    aortic stenosis, aortic valve replacement, left ventricular mass index, global longitudinal strain

    DOI

    https://doi.org/10.15836/ccar2018.379

    Full Text

    Objectives: Aortic stenosis is accompanied by progressive left ventricular hypertrophy and fibrosis. ( 1 ) This study sought to investigate the intensity of potential reversal changes in left ventricular (LV) mass and global longitudinal strain at 3 months follow up after aortic valve replacement surgery. Patients and Methods: A total of 47 patients (age 70.32 ± 7.59 years; 53,2% female) with severe, symptomatic AS were assessed pre-aortic valve replacement (AVR) by echocardiography. Bioprostheses were implanted in 41 patients (87.23%), and the 6 remaining patients (12.77%) received mechanical prostheses. Assessment was repeated at three months post-AVR. Results : At three months post-operatively the mean valve gradient had improved (52.05±13.38 mmHg to 13.05±4.36 mm Hg; p<0.001), and indexed LV mass had regressed by 10.85% (180.91±43.96 g/m 2 to 169.18±38.15 g/m 2 ; p<0.001). However, at three months post-AVR, these changes were not accompanied by reduction in LV end-diastolic volume index (57.74±16.78 ml/m 2 to 61.45±17.34 ml/m 2 ) and LV end-systolic volume index (25.42±11.09 ml/m 2 to 27.05± 12.25ml/m 2 ; P=0.294). Also, left ventricular ejection fraction (LVEF) did not improve (P=0.66). Nevertheless, septal thickness (P<0.001), posterior (PWT) wall thickness (P=0.001), and relative (RWT) wall thickness (P=0.032) were significantly reduced at follow-up. In addition, average global longitudinal strain (GLS; -15.86±4.25 to -17.16±3.42; P=0.008) and strain measured in two chamber view (2ch; -15.13±5.19 to -16.66±3.87; P=0.013) were also significantly improved while the strain measured in PLAX (-16.83±4.92 to -17.92±4.12; P=0.128) and in four-chamber view (4ch; -15.48±4.64 to -19.06±16.72; P=0.128) showed statistically insignificant improvement at 3 months follow up. There was no statistically significant improvement in diastolic function of LV. Conclusions: Three months post-AVR patients showed significant improvement in LV systolic function measured by GLS but not LVEF as well as improvement in reverse remodeling depicted by regression in LV mass. We did not see improvement in LV diastolic function.

    Cardiologia Croatica
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    Reversal of left ventricular mass and global longitudinal strain in patients with severe aortic valve stenosis at three-month follow-up after aortic valve surgery replacement

    Extended Abstract
    Issue11-12
    Published
    Pages379
    PDF via DOIhttps://doi.org/10.15836/ccar2018.379
    aortic stenosis
    aortic valve replacement
    left ventricular mass index
    global longitudinal strain

    Authors

    Ivana Jurin*ORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Josip VarvodićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Dubravka ŠušnjarORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Irzal HadžibegovićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Tomo SvagušaORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Tomislav LetilovićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Stipe RadošORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Nino TičinovićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Jasenka GrgurićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Frane PaićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Igor RudežORCIDUniversity Hospital Dubrava, Zagreb, Croatia

    Full Text

    Objectives: Aortic stenosis is accompanied by progressive left ventricular hypertrophy and fibrosis. ( 1 ) This study sought to investigate the intensity of potential reversal changes in left ventricular (LV) mass and global longitudinal strain at 3 months follow up after aortic valve replacement surgery. Patients and Methods: A total of 47 patients (age 70.32 ± 7.59 years; 53,2% female) with severe, symptomatic AS were assessed pre-aortic valve replacement (AVR) by echocardiography. Bioprostheses were implanted in 41 patients (87.23%), and the 6 remaining patients (12.77%) received mechanical prostheses. Assessment was repeated at three months post-AVR. Results : At three months post-operatively the mean valve gradient had improved (52.05±13.38 mmHg to 13.05±4.36 mm Hg; p<0.001), and indexed LV mass had regressed by 10.85% (180.91±43.96 g/m 2 to 169.18±38.15 g/m 2 ; p<0.001). However, at three months post-AVR, these changes were not accompanied by reduction in LV end-diastolic volume index (57.74±16.78 ml/m 2 to 61.45±17.34 ml/m 2 ) and LV end-systolic volume index (25.42±11.09 ml/m 2 to 27.05± 12.25ml/m 2 ; P=0.294). Also, left ventricular ejection fraction (LVEF) did not improve (P=0.66). Nevertheless, septal thickness (P<0.001), posterior (PWT) wall thickness (P=0.001), and relative (RWT) wall thickness (P=0.032) were significantly reduced at follow-up. In addition, average global longitudinal strain (GLS; -15.86±4.25 to -17.16±3.42; P=0.008) and strain measured in two chamber view (2ch; -15.13±5.19 to -16.66±3.87; P=0.013) were also significantly improved while the strain measured in PLAX (-16.83±4.92 to -17.92±4.12; P=0.128) and in four-chamber view (4ch; -15.48±4.64 to -19.06±16.72; P=0.128) showed statistically insignificant improvement at 3 months follow up. There was no statistically significant improvement in diastolic function of LV. Conclusions: Three months post-AVR patients showed significant improvement in LV systolic function measured by GLS but not LVEF as well as improvement in reverse remodeling depicted by regression in LV mass. We did not see improvement in LV diastolic function.