PMID- 27875727
OWN - NLM
STAT- MEDLINE
DCOM- 20171109
LR  - 20220321
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 228
DP  - 2017 Feb 1
TI  - Predictor of left ventricular dysfunction after aortic valve replacement in mixed 
      aortic valve disease.
PG  - 511-517
LID - S0167-5273(16)33777-9 [pii]
LID - 10.1016/j.ijcard.2016.11.237 [doi]
AB  - BACKGROUND: The fate of the left ventricle (LV) after aortic valve replacement 
      (AVR) in mixed aortic valve disease (MAVD) is unknown. METHODS: Patients with 
      moderate-severe MAVD, ejection fraction >/=50%, and no coronary artery disease who 
      underwent AVR were identified. Moderate-severe MAVD was defined as a combination 
      of >/=moderate aortic stenosis and >/=moderate aortic regurgitation. Assessment for 
      LVD was performed at 1 and 5years after AVR. The purpose of the study was to 
      determine prevalence and predictors of early and late left ventricular 
      dysfunction (LVD) defined as ejection fraction <50% at 1 and 5years post-AVR. The 
      severity of LV hypertrophy was assessed using LV mass index (LVMI), while 
      relative wall thickness (RWT) was used to determine the type of hypertrophy. RWT 
      was calculated as (2xposterior wall thickness)/LV end-diastolic dimension 
      (LVEDD). A RWT score >/=0.42 and <0.42 indicates concentric and eccentric 
      hypertrophy respectively. RESULTS: Patients with MAVD (n=179); age 63+/-8years, 
      males 134 (75%); underwent AVR at Mayo Clinic, 1994-2010. Early LVD occurred in 
      38(21%). Predictors of early LVD were LVMI/LVEDD >3.1 (HR 1.83, CI 1.59-1.98); 
      RWT >0.46 (HR 2.16, CI 1.21-4.99); and older age (HR 1.62, CI 1.23-3.02). 
      Assessment of LV function was performed in 124 patients at 5-years post-AVR, and 
      late LVD was present in 29(23%). Predictors of late LVD were LVMI/LVEDD >3.1 (HR 
      1.77, CI 1.24-2.01) and RWT >0.46 (HR 1.65, CI 1.29-2.24). All-cause mortality 
      occurred in 21(12%), and was more common in patients with LVMI/LVEDD >3.1 
      (P=0.043) and RWT >0.46 (P=0.029). Patients with postoperative LVD showed less 
      regression of LV mass after AVR even after controlling for blood pressure. 
      CONCLUSIONS: LVD can occur after AVR even in the setting of normal preoperative 
      LV function and absence of coronary artery disease. Preoperative LV mass was 
      predictive of LVD and should be taken into consideration when determining the 
      timing of AVR.
CI  - Copyright (c) 2016 Elsevier Ireland Ltd. All rights reserved.
FAU - Egbe, Alexander C
AU  - Egbe AC
AD  - Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic 
      address: egbe.alexander@mayo.edu.
FAU - Warnes, Carole A
AU  - Warnes CA
AD  - Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic 
      address: warnes.carole@mayo.edu.
LA  - eng
PT  - Journal Article
DEP - 20161114
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
SB  - IM
MH  - Aortic Valve/surgery
MH  - Aortic Valve Insufficiency/complications/diagnosis/*surgery
MH  - Aortic Valve Stenosis/complications/diagnosis/*surgery
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Prosthesis Implantation/*adverse effects
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/diagnosis/*epidemiology/physiopathology
MH  - Prevalence
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Stroke Volume
MH  - Time Factors
MH  - United States/epidemiology
MH  - Ventricular Dysfunction, Left/diagnosis/*epidemiology/physiopathology
MH  - Ventricular Function, Left/*physiology
OTO - NOTNLM
OT  - Aortic valve replacement
OT  - Left ventricle dysfunction
OT  - Left ventricular mass
OT  - Mixed aortic valve disease
EDAT- 2016/11/23 06:00
MHDA- 2017/11/10 06:00
CRDT- 2016/11/23 06:00
PHST- 2016/07/02 00:00 [received]
PHST- 2016/11/05 00:00 [revised]
PHST- 2016/11/10 00:00 [accepted]
PHST- 2016/11/23 06:00 [pubmed]
PHST- 2017/11/10 06:00 [medline]
PHST- 2016/11/23 06:00 [entrez]
AID - S0167-5273(16)33777-9 [pii]
AID - 10.1016/j.ijcard.2016.11.237 [doi]
PST - ppublish
SO  - Int J Cardiol. 2017 Feb 1;228:511-517. doi: 10.1016/j.ijcard.2016.11.237. Epub 
      2016 Nov 14.