Failure of left ventricular hypertrophy to regress after surgery for aortic valve stenosis.
BACKGROUND
Regression of left ventricular (LV) hypertrophy usually follows surgery for aortic stenosis (AS); however, a significant number of ventricles remain hypertrophied. The extent of this phenomenon, the reasons for failure to regress, and its significance are unclear.


METHODS
We investigated 43 patients before and after aortic valve surgery and divided them into two groups: 30 patients with regression of LV hypertrophy (Group A) and 13 patients without regression (Group B). Preoperative echocardiographic measurements, clinical status, and operative factors were compared between the two groups. The patients were followed up for 42 +/- 22 months for the occurrence of hospitalization for congestive heart failure (CHF) or death.


RESULTS
Preoperatively, the two groups were similar except for an excess of patients in New York Heart Association (NYHA) functional Class IV and a greater incidence of old myocardial infarcts in Group B. Postoperatively, Group B patients had larger LVs with decreased systolic function. This was associated with a poor prognosis (23% mortality and 38% CHF vs 0% and 4% for Group A patients, P = 0.0002). Cox regression analysis showed previous myocardial infarction (P < 0.001) and percent mass reduction (P = 0.019) to be independent predictors of CHF or death.


CONCLUSIONS
Successful regression of LV mass is difficult to predict before surgery; however, its absence is related strongly to a poor long-term prognosis.
Lessick
Jonathan
J
Department of Cardiology, Rambam Medical Center, Haifa, Israel.
Mutlak
Diab
D
Markiewicz
Walter
W
Reisner
Shimon A
SA
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D015995:Prevalence; D011336:Probability; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome