AI Article Synopsis
- The study investigates how patient-prosthesis mismatch (PPM) affects long-term heart health, particularly after aortic valve replacement (AVR) for aortic stenosis, focusing on relationships between hemodynamic parameters and left ventricular (LV) mass regression.
- Data from 120 patients showed that specific hemodynamic factors, such as a lower effective orifice area and a higher mean transvalvular pressure gradient, were linked to less reduction in LV mass, while higher valvuloarterial impedance and LV mass indicated a greater risk of major adverse cardiovascular and cerebral events (MACCE).
- Key findings included that less than 14% regression in LV mass significantly predicted higher risk of MACCE,
Article Abstract
Patient-prosthesis mismatch (PPM) causes a high transvalvular pressure gradient and residual left ventricular (LV) hypertrophy, consequently influencing long-term results. This study aimed to find the relationships between hemodynamic parameters and LV mass regression and determine the risk predictors of major adverse cardiovascular and cerebral events (MACCE) after aortic valve replacement (AVR) for aortic stenosis. Preoperative and postoperative Doppler echocardiography data were evaluated for 120 patients after AVR. The patients' mean age was 67.7 years; 55% of the patients were male. Forty-four (37%) patients suffered from MACCE during a mean follow-up period of 3.6 ± 2 years. The following hemodynamic parameters at follow-up were associated with lower relative indexed LV mass (LVMI) regression: lower postoperative indexed effective orifice area, greater mean transvalvular pressure gradient (MPG), greater stroke work loss (SWL), and concentric or eccentric LV remodeling mode. The following hemodynamic parameters at follow-up were associated with a higher risk of MACCE: higher valvuloarterial impedance (Z), greater SWL, greater MPG, greater relative wall thickness, greater LVMI, and hypertrophic LV remodeling mode. Lower relative LVMI regression was associated with a higher risk of MACCE (hazard ratio, 1.01: 95% confidence interval, 1.003-1.03). The corresponding cutoff of relative LVMI regression was -14%. Changes in hemodynamic parameters were independently associated with relative LVMI regression. Impaired reverse remodeling and persistent residual LV hypertrophy were independent risk predictors of MACCE. An LVMI regression lower than 14% indicated higher MACCE. A postoperative Z greater than 3.5 mmHg/mL/m was an independent risk predictor of cardiac events and mortality after AVR. Preventive strategies should be used at the time of the operation to avoid PPM.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9783780 | PMC |
| http://dx.doi.org/10.3390/jcm11247482 | DOI Listing |
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