Incidence and Risk Factors for Long-Term Persistence of Diastolic Dysfunction after Aortic Valve Replacement for Aortic Stenosis Compared with Aortic Regurgitation

Author:

Iliuță Luminița12ORCID,Andronesi Andreea Gabriella34ORCID,Scafa-Udriște Alexandru56,Rădulescu Bogdan57,Moldovan Horațiu589,Furtunescu Florentina Ligia10ORCID,Panaitescu Eugenia1ORCID

Affiliation:

1. Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania

2. Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania

3. Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania

4. Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania

5. Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania

6. Department of Cardiology, Clinical Emergency Hospital, 014461 Bucharest, Romania

7. Department of Cardiovascular Surgery, Emergency Institute for cardiovascular diseases “C.C Iliescu”, 022328 Bucharest, Romania

8. Academy of Romanian Scientists (AOSR), 3 Ilfov Street, 050044 Bucharest, Romania

9. Department of Cardiovascular Surgery, Clinical Emergency Hospital, 014461 Bucharest, Romania

10. Department of Public Health and Management, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania

Abstract

(1) Background: Severe left ventricular (LV) diastolic dysfunction with a restrictive diastolic pattern (LVDFP) is generally associated with a worse prognosis. Its evolution and reversibility in the short- and medium-term after aortic valve replacement (AVR) has been little-studied. We aimed to evaluate the evolution of LV remodeling and LV systolic and diastolic function after AVR in aortic stenosis (AS) patients compared to aortic regurgitation (AR). Moreover, we tried to identify the main predictive parameters for postoperative evolution (cardiovascular hospitalization or death and quality of life) and the independent predictors for the persistence of restrictive LVDFP after AVR. (2) Methods: A five-year prospective study on 397 patients undergoing AVR for AS (226 pts) or AR (171 pts), evaluated clinically and by echocardiography preoperatively and until 5 years postoperatively. (3) Results: 1. In patients with AS, early post AVR, LV dimensions decreased and diastolic filling and LV ejection fraction (LVEF) improved more rapidly compared to patients with AR. At 1 year postoperatively, persistent restrictive LVDFP was found especially in the AR group compared to the AS group (36.84% vs. 14.16%). 2. Cardiovascular event-free survival at the 5-year follow-up was lower in the AR group (64.91% vs. 87.17% in the AS group). The main independent predictors of short- and medium-term prognosis after AVR were: restrictive LVDFP, severe LV systolic dysfunction, severe pulmonary hypertension (PHT), advanced age, severe AR, and comorbidities. 3. The persistence of restrictive LVDFP after AVR was independently predicted by: preoperative AR, the E/Ea ratio > 12, the LA dimension index > 30 mm/m2, an LV endsystolic diameter (LVESD) > 55 mm, severe PHT, and associated second-degree MR (p < 0.05). (4) Conclusions: AS patients had an immediate postoperative evolution in terms of LV remodeling, and LV systolic and diastolic function were more favorable compared to those with AR. The restrictive LVDFP was reversible, especially after the AVR for AS. The main prognostic predictors were the presence of restrictive LVDFP, advanced age, preoperative AR, severe LV systolic dysfunction, and severe PHT.

Publisher

MDPI AG

Subject

Pharmacology (medical),General Pharmacology, Toxicology and Pharmaceutics

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