Usefulness of preoperative stroke volume as strong predictor of left ventricular remodeling and outcomes after aortic valve replacement in patients with severe pure aortic regurgitation

Mario Sénéchal, Mathieu Bernier, François Dagenais, Michelle Dubois, Isaïe-Nicolas Dubois-Sénéchal, Pierre Voisine
American Journal of Cardiology 2011 October 1, 108 (7): 1008-13
In most patients with aortic regurgitation (AR), aortic valve replacement (AVR) results in favorable left ventricular (LV) remodeling and normalization of the LV ejection fraction (EF). However, some patients with severe AR will not have favorable remodeling and their LVEF will not normalize. The goal of the present study was to determine whether remodeling and clinical outcomes after AVR could be predicted from simple preoperative echocardiographic analysis. A total of 56 consecutive patients with chronic severe pure AR who underwent AVR had preoperative (5 ± 2 days), early postoperative (5 ± 2 days), and late postoperative (328 ± 88 days) echocardiographic data retrospectively analyzed. The LV diameter, The LVEF and stroke volume (SV) were measured. The reduction in LV end-diastolic dimension decreased by 14% (from 65 ± 6 mm to 56 ± 8 mm, p <0.001) early after AVR, with an additional reduction of only 6% late after AVR. More than 2/3 of the overall reduction in end-diastolic dimension was observed the week after AVR. Forty-six patients (82%) had positive early LV remodeling, defined as a 10% reduction in the LV end-diastolic diameter 1 week after AVR. All patients with early LV remodeling had a preoperative SV of ≥97 ml, which was the best predictor of late postoperative LVEF of ≥45% (sensitivity 98% and specificity 100%). Patients with a preoperative SV of ≥97 ml had a markedly greater event-free survival rate (92% vs 13%, p <0.001) at 3 years. In conclusion, in patients undergoing AVR for chronic severe pure AR, preoperative SV is the best predictor of LV remodeling and outcomes.

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