One-Week Postoperative Valvuloarterial Impedance as a Predictor of Left Ventricular Hypertrophy Regression 1 Year After Surgical Aortic Valve Replacement in Patients With Aortic Stenosis.

Abstract

Background: Persistent left ventricular hypertrophy (LVH) after surgical aortic valve replacement (SAVR) for aortic stenosis (AS) worsens prognosis. We investigated predictors of LVH regression 1 year after SAVR in AS patients, including patient-prosthesis mismatch (PPM) and valvuloarterial impedance (Zva).

Methods and results: We retrospectively studied 175 patients who underwent SAVR for AS at Jichi Medical University between 2014 and 2019. Echocardiography was performed at preoperative baseline, 1-week postoperative, and 1-year postoperative. The left ventricular mass index (LVMI) regression rate (RR) was defined as the difference between baseline LVMI and 1-year LVMI divided by baseline LVMI. Patients were divided into 2 groups based on their median LVMI RR as follows: (1) a poor LVH regression (PR-LVH) group with values below the median LVMI RR; and (2) a good LVH regression (GR-LVH) group with values above the median LVMI RR. The median LVMI RR was 25.4%. There were 88 (50.3%) patients in the PR-LVH group. In the multivariable analysis, 1-week postoperative Zva (odds ratio [OR] 2.777; 95% confidence interval [CI] 1.584-4.869; P<0.001) and baseline LVMI per 10-unit increment (OR 0.974; 95% CI 0.960-0.988; P=0.001) were independent predictors of PR-LVH. The receiver operating characteristic curve analysis identified Zva ≥3.5 mmHg/mL/m² as a cut-off value associated with PR-LVH.

Conclusions: One-week postoperative Zva was a better predictor of improved LVH at 1 year after SAVR than PPM.