PMID- 30138945
OWN - NLM
STAT- MEDLINE
DCOM- 20191016
LR  - 20191016
IS  - 1421-9751 (Electronic)
IS  - 0008-6312 (Print)
IS  - 0008-6312 (Linking)
VI  - 140
IP  - 4
DP  - 2018
TI  - Survival after Aortic Valve Replacement for Aortic Regurgitation: Prediction from 
      Preoperative Contractility Measurement.
PG  - 204-212
LID - 10.1159/000490848 [doi]
AB  - BACKGROUND: Noninvasive measurement of myocardial contractility (end-systolic 
      wall stress-adjusted change in left ventricular ejection fraction from rest to 
      exercise [DeltaLVEF - DeltaESS]) predicts heart failure, subnormal LVEFrest, and sudden 
      death in asymptomatic patients with chronic severe aortic regurgitation (AR). 
      Here we assess the relation of preoperative DeltaLVEF - DeltaESS to survival after aortic 
      valve replacement (AVR). METHODS: Patients who underwent AVR for chronic, 
      isolated, pure severe AR (n = 66) were followed for 13.0 +/- 6.4 event-free years. 
      Preoperative DeltaLVEF - DeltaESS (from combined echocardiographic and radionuclide 
      cineangiographic data) enabled cohort stratification into 3 terciles (-1 to -11% 
      [normal or mild] contractility deficit, -12 to -16% [moderate], and </=-17% 
      [severe], identical with segregation in our earlier study) to relate preoperative 
      contractility to postoperative survival and to age- and gender-matched US census 
      data. RESULTS: Since AVR, 22 patients died (average annual risk [AAR] for 
      all-cause mortality for the entire co hort = 3.15%). Preoperative DeltaLVEF - DeltaESS 
      predicted postoperative survival (p = 0.009, log rank test). By contractility 
      terciles, all-cause AARs were 1.44, 2.58, and 6.40%. Survival was lower than 
      among US census comparators (p < 0.02), but the "mild" tercile was 
      indistinguishable from census data (p = ns). By multivariable Cox regression, 
      survival prediction by pre-AVR DeltaLVEF - DeltaESS was independent of, and superior to, 
      prediction by age at surgery, gender, preoperative functional class, LVEFrest, 
      LVEFexercise, change in LVEFrest to exercise, and LV diastolic or systolic 
      dimensions (p </= 0.01, pre-AVR DeltaLVEF - DeltaESS vs. other covariates). CONCLUSION: In 
      severe AR, preoperative contractility predicts post-AVR survival and may be 
      prognostically superior to clinical, geometric and performance descriptors, 
      potentially impacting on patient selection for surgery.
CI  - (c) 2018 The Author(s) Published by S. Karger AG, Basel.
FAU - Borer, Jeffrey S
AU  - Borer JS
AD  - Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart 
      Valve Disease, State University of New York Downstate Medical Center, Brooklyn, 
      New York, USA.
FAU - Supino, Phyllis G
AU  - Supino PG
AD  - Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart 
      Valve Disease, State University of New York Downstate Medical Center, Brooklyn, 
      New York, USA.
FAU - Herrold, Edmund McM
AU  - Herrold EM
AD  - Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart 
      Valve Disease, State University of New York Downstate Medical Center, Brooklyn, 
      New York, USA.
FAU - Innasimuthu, Antony
AU  - Innasimuthu A
AD  - Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart 
      Valve Disease, State University of New York Downstate Medical Center, Brooklyn, 
      New York, USA.
FAU - Hochreiter, Clare
AU  - Hochreiter C
AD  - Department of Cardiothoracic Surgery, Weill Medical College of Cornell 
      University, New York, New York, USA.
FAU - Krieger, Karl
AU  - Krieger K
AD  - Department of Cardiothoracic Surgery, Weill Medical College of Cornell 
      University, New York, New York, USA.
FAU - Girardi, Leonard N
AU  - Girardi LN
AD  - Department of Cardiothoracic Surgery, Weill Medical College of Cornell 
      University, New York, New York, USA.
FAU - Isom, O Wayne
AU  - Isom OW
AD  - Department of Cardiothoracic Surgery, Weill Medical College of Cornell 
      University, New York, New York, USA.
LA  - eng
GR  - R01 HL026504/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20180823
PL  - Switzerland
TA  - Cardiology
JT  - Cardiology
JID - 1266406
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aortic Valve Insufficiency/diagnostic imaging/*mortality/surgery
MH  - Censuses
MH  - Coronary Angiography
MH  - Disease Progression
MH  - Echocardiography
MH  - Exercise Test/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Contraction/*physiology
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk Factors
MH  - Survival
MH  - Treatment Outcome
MH  - United States/epidemiology
MH  - Ventricular Function, Left
MH  - Young Adult
PMC - PMC6262682
OTO - NOTNLM
OT  - Exercise testing
OT  - Radionuclide cineangiography
OT  - Valvular heart disease
EDAT- 2018/08/24 06:00
MHDA- 2019/10/17 06:00
PMCR- 2018/08/23
CRDT- 2018/08/24 06:00
PHST- 2018/05/29 00:00 [received]
PHST- 2018/05/31 00:00 [accepted]
PHST- 2018/08/24 06:00 [pubmed]
PHST- 2019/10/17 06:00 [medline]
PHST- 2018/08/24 06:00 [entrez]
PHST- 2018/08/23 00:00 [pmc-release]
AID - 000490848 [pii]
AID - crd-0140-0204 [pii]
AID - 10.1159/000490848 [doi]
PST - ppublish
SO  - Cardiology. 2018;140(4):204-212. doi: 10.1159/000490848. Epub 2018 Aug 23.