title: Implications of increased left ventricular mass index on in-hospital outcomes in patients undergoing aortic valve surgery.
abstract: BACKGROUND
  Increased left ventricular mass index has been shown to be associated with higher mortality in epidemiologic studies. However, the effect of increased left ventricular mass index on outcomes in patients undergoing aortic valve replacement is unknown.
  
  
  METHODS
  We studied 473 consecutive patients undergoing elective aortic valve replacement to assess the influence of left ventricular mass index on outcomes in patients having this procedure. Echocardiographic left ventricular dimensions were used to calculate left ventricular mass index (considered increased if >134 g/m(2) in male patients and >110 g/m(2) in female patients).
  
  
  RESULTS
  Left ventricular mass index was increased in 24% of patients undergoing aortic valve replacement. Postprocedural complications (respiratory failure, renal insufficiency, congestive heart failure, and atrial and ventricular arrhythmias), length of stay in the intensive care unit, and in-hospital mortality were increased in patients with increased left ventricular mass index. Multivariable analysis identified prior valve surgery (odds ratio, 4.3; 95% confidence interval, 1.2-15.7; P =.030), left ventricular ejection fraction (odds ratio, 1.07; 95% confidence interval, 1.01-1.14; P =.020), history of hypertension (odds ratio, 8.2; 95% confidence interval, 2.2-30.4; P =.002), history of liver disease (odds ratio, 50.4; 95% confidence interval, 4.2-609.0; P =.002), and increased left ventricular mass index (odds ratio, 38; 95% confidence interval, 9.3-154.1; P <.001) as independent predictors of in-hospital mortality. Furthermore, low output syndrome was identified as the most common mode of death (36%) after aortic valve replacement in patients with increased left ventricular mass index.
  
  
  CONCLUSIONS
  Increased left ventricular mass index is associated with increased adverse in-hospital clinical outcomes in patients undergoing aortic valve replacement. Although this finding warrants special modification in perioperative management, further studies are needed to address whether outcomes in asymptomatic patients with aortic valve disease could be improved by earlier aortic valve replacement before a significant increase in left ventricular mass index.
authors.affiliation: Division of Cardiology and Section of Adult Cardiac Surgery, Heart Care Program, University of Michigan, Ann Arbor, MI48109-0348, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Mehta
authors.forename: D
authors.initials: D
authors.lastname: Bruckman
authors.forename: S
authors.initials: S
authors.lastname: Das
authors.forename: T
authors.initials: T
authors.lastname: Tsai
authors.forename: P
authors.initials: P
authors.lastname: Russman
authors.forename: D
authors.initials: D
authors.lastname: Karavite
authors.forename: H
authors.initials: H
authors.lastname: Monaghan
authors.forename: S
authors.initials: S
authors.lastname: Sonnad
authors.forename: M J
authors.initials: MJ
authors.lastname: Shea
authors.forename: K A
authors.initials: KA
authors.lastname: Eagle
authors.forename: G M
authors.initials: GM
authors.lastname: Deeb
mesh_terms: D001021:Aortic Valve; D002303:Cardiac Output, Low / Q000453:epidemiology; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome