Influence of preoperative left ventricular contractile reserve on postoperative ejection fraction in low-gradient aortic stenosis.
BACKGROUND
Dobutamine stress hemodynamics (DSH) has the potential to stratify operative risk in low-gradient aortic stenosis (AS), but little is known about the relation between left ventricle contractile reserve and postoperative left ventricular ejection fraction (LVEF). We sought to assess the value of DSH to predict postoperative improvement in LVEF.


RESULTS
Sixty-six consecutive patients with symptomatic severe AS (aortic valve area < or =1 cm2), LVEF < or =40%, and mean pressure gradient < or =40 mm Hg prospectively enrolled in the French multicenter study on low-gradient AS and who survived to aortic valvular replacement (AVR) were included. Preoperative contractile reserve was present in 46 patients (group I; 70%) and absent in 20 patients (group II; 30%). In the overall sample, 58% of patients improved by 2 New York Heart Association (NYHA) classes after AVR. Mean LVEF improved from 29+/-6% to 47+/-11% (P<0.0001). LVEF improved by > or =10 EF units in 38 patients (83%) in group I and in 13 patients (65%) in group II. Mean LVEF improvement was similar in the 2 groups (19+/-10% versus 17+/-11%; P=0.54). On multivariable analysis, multivessel coronary artery disease (P=0.05) and baseline mean transaortic pressure gradient (P=0.01) were related to LVEF improvement, whereas contractile reserve was not.


CONCLUSIONS
LVEF increases in the majority of patients with low-gradient AS who survive after AVR. Although the absence of contractile reserve on DSH is related to high operative mortality, it does not predict the absence of LVEF recovery in patients surviving to AVR. These data further support the concept that surgery should not be contraindicated on the basis of absence of contractile reserve alone.
Department of Cardiology, INSERM, ERI-12, University Hospital, Amiens, France.
Jean-Paul
JP
Quere
Jean-Luc
JL
Monin
Franck
F
Levy
Hélène
H
Petit
Serge
S
Baleynaud
Christophe
C
Chauvel
Camélia
C
Pop
Patrick
P
Ohlmann
Claude
C
Lelguen
Patrick
P
Dehant
Pascal
P
Gueret
Christophe
C
Tribouilloy
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D004280:Dobutamine; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011184:Postoperative Period; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*
D004280:Dobutamine