title: Enhanced left ventricular mass regression after aortic valve replacement in patients with aortic stenosis is associated with improved long-term survival.
abstract: BACKGROUND
  Aortic valve replacement in patients with aortic stenosis is usually followed by regression of left ventricular hypertrophy. More complete resolution of left ventricular hypertrophy is suggested to be associated with superior clinical outcomes; however, its translational impact on long-term survival after aortic valve replacement has not been investigated.
  
  
  METHODS
  Demographic, operative, and clinical data were obtained retrospectively through case note review. Transthoracic echocardiography was used to measure left ventricular mass preoperatively and at annual follow-up visits. Patients were classified according to their reduction in left ventricular mass at 1 year after the operation: group 1, less than 25 g; group 2, 25 to 150 g; and group 3, more than 150 g. Kaplan-Meier and multivariable Cox regression were used.
  
  
  RESULTS
  A total of 147 patients were discharged from the hospital after aortic valve replacement for aortic stenosis between 1991 and 2001. Preoperative left ventricular mass was 279 ± 98 g in group 1 (n = 47), 347 ± 104 g in group 2 (n = 62), and 491 ± 183 g in group 3 (n = 38) (P < .001). Mean time to last echocardiogram was 6.2 ± 3.2 years. Left ventricular mass at late follow-up was 310 ± 119 g in group 1, 267 ± 107 g in group 2, and 259 ± 96 g in group 3 (P = .05). Transvalvular gradients at follow-up were not significantly different among the groups (group 1, 24.8 ± 23 mm Hg; group 2, 21.4 ± 16 mm Hg; group 3, 14.7 ± 9 mm Hg) (P = .31). There was no difference in the prevalence of other factors influencing left ventricular mass regression such as ischemic heart disease or hypertension, valve type, or valve size used. Ten-year actuarial survival was not statistically different in patients with enhanced left ventricular mass regression when compared with the log-rank test (group 1, 51% ± 9%; group 2, 54% ± 8%; and group 3, 72% ± 10%) (P = .26). After adjustment, left ventricular mass reduction of more than 150 g was demonstrated as an independent predictor of improved long-term survival on multivariate analysis (P = .02).
  
  
  CONCLUSIONS
  Our study is the first to suggest that enhanced postoperative left ventricular mass regression, specifically in patients undergoing aortic valve replacement for aortic stenosis, may be associated with improved long-term survival. In view of these findings, strategies purported to be associated with superior left ventricular mass regression should be considered when undertaking aortic valve replacement.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom. ayyaz75@gmail.com
authors.forename: Ayyaz
authors.initials: A
authors.lastname: Ali
authors.forename: Amit
authors.initials: A
authors.lastname: Patel
authors.forename: Ziad
authors.initials: Z
authors.lastname: Ali
authors.forename: Yasir
authors.initials: Y
authors.lastname: Abu-Omar
authors.forename: Amber
authors.initials: A
authors.lastname: Saeed
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: John
authors.initials: J
authors.lastname: Pepper
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000401:mortality; D008297:Male; D011184:Postoperative Period; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate