Impact of Valvuloarterial Impedance on Concentric Remodeling in Aortic Stenosis and Its Regression after Valve Replacement
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Background: Left ventricle (LV) in patients with aortic stenosis (AS) faces a double hemodynamic load incorporating both valvularstenosis and reduced systemic arterial compliance (SAC). This study aimed to evaluate the impact of global LV afterload onLV hypertrophy (LVH) before and after aortic valve replacement (AVR). Methods: The study cohort included 453 patients (247 males; mean age, 64 ± 11 years) who underwent AVR. Pre- and post-AVR echocardiographic examinations were retrospectively analyzed including an index of valvuloarterial impedance (ZVA) and LVmass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LVH. Results: Pre-AVR LVMI/LVEDVI was 2.7 ± 0.9 g/mL with an aortic valve area (AVA) of 0.6 ± 0.2 cm2. ZVA was 5.9 ± 1.9mm Hg/mL/m2 and showed a stronger correlation (β = 0.601, p < 0.001) with pre-AVR LVMI/LVEDVI than indexed AVA (β =0.061, p = 0.19), transvalvular peak velocity (β = 0.211, p < 0.001). During a median follow-up of 3.5 years, patients had a 18.8± 10.4% decrease in the LV geometry index with a decrease in SAC from 1.20 ± 0.48 to 1.00 ± 0.38 mL/m2/mm Hg (p < 0.001). Pre-AVR LV ejection fraction (r = 0.284, p < 0.001) and ZVA (r = 0.523, p < 0.001) were independent factors associated with LVHregression in 322 patients with follow-up duration >1 year after AVR. Conclusion: ZVA is a major determinant of concentric remodeling in AS before AVR and LVH regression after AVR, whichshould be incorporated in routine evaluation of AS.
Abstract
Background: Left ventricle (LV) in patients with aortic stenosis (AS) faces a double hemodynamic load incorporating both valvularstenosis and reduced systemic arterial compliance (SAC). This study aimed to evaluate the impact of global LV afterload onLV hypertrophy (LVH) before and after aortic valve replacement (AVR). Methods: The study cohort included 453 patients (247 males; mean age, 64 ± 11 years) who underwent AVR. Pre- and post-AVR echocardiographic examinations were retrospectively analyzed including an index of valvuloarterial impedance (ZVA) and LVmass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LVH. Results: Pre-AVR LVMI/LVEDVI was 2.7 ± 0.9 g/mL with an aortic valve area (AVA) of 0.6 ± 0.2 cm2. ZVA was 5.9 ± 1.9mm Hg/mL/m2 and showed a stronger correlation (β = 0.601, p < 0.001) with pre-AVR LVMI/LVEDVI than indexed AVA (β =0.061, p = 0.19), transvalvular peak velocity (β = 0.211, p < 0.001). During a median follow-up of 3.5 years, patients had a 18.8± 10.4% decrease in the LV geometry index with a decrease in SAC from 1.20 ± 0.48 to 1.00 ± 0.38 mL/m2/mm Hg (p < 0.001). Pre-AVR LV ejection fraction (r = 0.284, p < 0.001) and ZVA (r = 0.523, p < 0.001) were independent factors associated with LVHregression in 322 patients with follow-up duration >1 year after AVR. Conclusion: ZVA is a major determinant of concentric remodeling in AS before AVR and LVH regression after AVR, whichshould be incorporated in routine evaluation of AS.
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