Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery

Marija Brestovac; Blanka Glavaš; Sandra Jakšić Jurinjak; Vlatka Rešković Lukšić; Martina Lovrić Benčić; Marijan Pašalić; Jadranka Šeparović Hanževački

doi:10.15836/ccar2024.456

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Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery

Extended Abstract

Issue11-12

PublishedNovember 2024

Pages456-457

PDF via DOIhttps://doi.org/10.15836/ccar2024.456

aortic regurgitation

left ventricle remodeling

timing for aortic valve replacement

Authors

Marija Brestovac*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

Blanka GlavašORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

Sandra Jakšić JurinjakORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

Vlatka Rešković LukšićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

Martina Lovrić BenčićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

Marijan PašalićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

Jadranka Šeparović HanževačkiORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

*Correspondence email: marija.brestovac@gmail.com

Full Text

Introduction: Significant aortic regurgitation (sAR) results in left ventricle (LV) remodeling and LV dysfunction due to chronic pressure and a volume overload. Timing of surgical intervention is defined by left ventricle ejection fraction (LVEF) 50 mm. (1, 2) The aim of this study was to investigate if there is difference in LV positive remodeling after AV surgery, according to LVEF above cut of value (EF>50%) at the timing of surgery.

Patients and Methods: We retrospectively analyzed echocardiographic (ECHO) database for 52 patients (pt) who underwent aortic valve surgery (AVR) from January 2017 to April 2021 due to sAR, in UHC Zagreb. Preoperative ECHO data as well as during follow-up (FU) were analyzed. The study population was divided in three groups according to initial LVEF values: group (I) included 17 pt with EF>60% (mean age 54+/-9.4), group (II) 16 pt with EF 50-60% (mean age 52+/-15.7) and group (III) 19 pt with EF2) and left ventricular internal dimension at end-systole (LVIDs, mm) were compared prior surgery and in the mean FU time of 38 months.

Results: The change in absolute values of ECHO parameters and their calculated mean change are shown in (Figure 1) and (Table 1). Preoperatively, group III revealed the highest EDV/ESV/LVIDs values 259.18/148.6/51 compared to group I and II (186.11/76.83/39.6 vs. 182.21/86.8/40.2). During FU after AVR, no difference in reduction in EDV and MM (EDV p=0.115, MM p=0.774) was noticed between the 3 groups, while absolute values almost reached normal ranges only in group I and II (EDV 138.7 in I and 138.8 in II). Importantly, normalization of ESV and LVIDs during FU was shown only in group I and II, while rate of change was highest in group III (ΔESV 40.3, ΔLVIDs 13.5), LVIDs decreased more in more dilated LV (p=0.006) and even though ESV reduced in all three groups, in group III it remained enlarged (p=0.006), as expected.

FIGURE 1. Change in absolute values of end-diastolic volume, end-systolic volume, myocardial mass, and left ventricular internal dimension at end-systole after aortic valve surgery in patients surgically treated due to significant aortic regurgitation.

TABLE 1: Absolute values and calculated change in end-diastolic volume, end-systolic volume, myocardial mass, and left ventricular internal dimension at end-systole in 3 patient groups divided according to ejection fraction prior to aortic valve surgery due to aortic regurgitation.

	Group — EF>60% — Mean	Group — EF>60% — Standard Deviation	Group — 50%<EF<60% — Mean	Group — 50%<EF<60% — Standard Deviation	Group — EF<50% — Mean	Group — EF<50% — Standard Deviation	p
EDV pre	186.11	62.46	182.21	52.65	259.18	87.95	0.002
EDV post	138.74	59.56	138.88	50.30	174.55	61.26	0.101
EDV delta	44.94	55.13	40.25	63.69	80.74	81.31	0.115
ESV pre	76.83	24.71	86.84	28.39	148.59	50.02	0.000
ESV post	69.74	38.89	66.81	22.05	105.75	53.67	0.018
ESV delta	8.47	35.10	20.63	34.26	40.37	42.92	0.006
MM pre	170.76	58.20	169.72	74.96	213.76	104.38	0.281
MM post	154.05	54.29	128.50	45.53	166.60	56.21	0.054
MM delta	18.63	79.81	34.63	44.33	43.68	111.59	0.774
LVIDs pre	39.68	7.45	43.22	6.66	51.82	10.34	<0.001
LVIDs post	38.29	11.06	35.38	4.86	41.45	11.50	0.192
LVIDs delta	1.50	12.30	11.16	13.48	13.52	23.14	0.006

pre = prior aortic valve surgery; post = in follow-up; delta = calculated change (pre-post); EF = ejection fraction; EDV = end-diastolic volume (ml); ESV = end-systolic volume (ml); MM = myocardial mass (g/m2); LVIDs = left ventricle end-systolic diameter (mm); p = statistical significance.

TABLE 1: Absolute values and calculated change in end-diastolic volume, end-systolic volume, myocardial mass, and left ventricular internal dimension at end-systole in 3 patient groups divided according to ejection fraction prior to aortic valve surgery due to aortic regurgitation.

EDV pre

Group — EF>60% — Mean: 186.11
Group — EF>60% — Standard Deviation: 62.46
Group — 50%<EF<60% — Mean: 182.21
Group — 50%<EF<60% — Standard Deviation: 52.65
Group — EF<50% — Mean: 259.18
Group — EF<50% — Standard Deviation: 87.95
p: 0.002

EDV post

Group — EF>60% — Mean: 138.74
Group — EF>60% — Standard Deviation: 59.56
Group — 50%<EF<60% — Mean: 138.88
Group — 50%<EF<60% — Standard Deviation: 50.30
Group — EF<50% — Mean: 174.55
Group — EF<50% — Standard Deviation: 61.26
p: 0.101

EDV delta

Group — EF>60% — Mean: 44.94
Group — EF>60% — Standard Deviation: 55.13
Group — 50%<EF<60% — Mean: 40.25
Group — 50%<EF<60% — Standard Deviation: 63.69
Group — EF<50% — Mean: 80.74
Group — EF<50% — Standard Deviation: 81.31
p: 0.115

ESV pre

Group — EF>60% — Mean: 76.83
Group — EF>60% — Standard Deviation: 24.71
Group — 50%<EF<60% — Mean: 86.84
Group — 50%<EF<60% — Standard Deviation: 28.39
Group — EF<50% — Mean: 148.59
Group — EF<50% — Standard Deviation: 50.02
p: 0.000

ESV post

Group — EF>60% — Mean: 69.74
Group — EF>60% — Standard Deviation: 38.89
Group — 50%<EF<60% — Mean: 66.81
Group — 50%<EF<60% — Standard Deviation: 22.05
Group — EF<50% — Mean: 105.75
Group — EF<50% — Standard Deviation: 53.67
p: 0.018

ESV delta

Group — EF>60% — Mean: 8.47
Group — EF>60% — Standard Deviation: 35.10
Group — 50%<EF<60% — Mean: 20.63
Group — 50%<EF<60% — Standard Deviation: 34.26
Group — EF<50% — Mean: 40.37
Group — EF<50% — Standard Deviation: 42.92
p: 0.006

MM pre

Group — EF>60% — Mean: 170.76
Group — EF>60% — Standard Deviation: 58.20
Group — 50%<EF<60% — Mean: 169.72
Group — 50%<EF<60% — Standard Deviation: 74.96
Group — EF<50% — Mean: 213.76
Group — EF<50% — Standard Deviation: 104.38
p: 0.281

MM post

Group — EF>60% — Mean: 154.05
Group — EF>60% — Standard Deviation: 54.29
Group — 50%<EF<60% — Mean: 128.50
Group — 50%<EF<60% — Standard Deviation: 45.53
Group — EF<50% — Mean: 166.60
Group — EF<50% — Standard Deviation: 56.21
p: 0.054

MM delta

Group — EF>60% — Mean: 18.63
Group — EF>60% — Standard Deviation: 79.81
Group — 50%<EF<60% — Mean: 34.63
Group — 50%<EF<60% — Standard Deviation: 44.33
Group — EF<50% — Mean: 43.68
Group — EF<50% — Standard Deviation: 111.59
p: 0.774

LVIDs pre

Group — EF>60% — Mean: 39.68
Group — EF>60% — Standard Deviation: 7.45
Group — 50%<EF<60% — Mean: 43.22
Group — 50%<EF<60% — Standard Deviation: 6.66
Group — EF<50% — Mean: 51.82
Group — EF<50% — Standard Deviation: 10.34
p: <0.001

LVIDs post

Group — EF>60% — Mean: 38.29
Group — EF>60% — Standard Deviation: 11.06
Group — 50%<EF<60% — Mean: 35.38
Group — 50%<EF<60% — Standard Deviation: 4.86
Group — EF<50% — Mean: 41.45
Group — EF<50% — Standard Deviation: 11.50
p: 0.192

LVIDs delta

Group — EF>60% — Mean: 1.50
Group — EF>60% — Standard Deviation: 12.30
Group — 50%<EF<60% — Mean: 11.16
Group — 50%<EF<60% — Standard Deviation: 13.48
Group — EF<50% — Mean: 13.52
Group — EF<50% — Standard Deviation: 23.14
p: 0.006

Conclusion: Our results confirmed LV positive remodeling after AVR due to chronic AR, indicating that initial LVEF prior AVR could predict residual LV dilatation despite the reduction in EDV after AVR. In patients with LVEF>60% preoperatively, reversible positive remodeling after AVR may occur with complete normalization of ESV/EDV and LVIDs values during FU.

Literature

1.
Vollema EM, Singh GK, Prihadi EA, Regeer MV, Ewe SH, Ng ACT, et al. Time course of left ventricular remodelling and mechanics after aortic valve surgery: aortic stenosis vs. aortic regurgitation. Eur Heart J Cardiovasc Imaging. 2019 October 1;20(10):1105–11.DOI
2.
Zhang MK, Li LN, Xue H, Tang XJ, Sun H, Wu QY. Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement. J Cardiothorac Surg. 2022 January 16;17(1):8.DOI

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Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery

Authors

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TABLE 1: Absolute values and calculated change in end-diastolic volume, end-systolic volume, myocardial mass, and left ventricular internal dimension at end-systole in 3 patient groups divided according to ejection fraction prior to aortic valve surgery due to aortic regurgitation.

Literature