title: LV reverse remodeling imparted by aortic valve replacement for severe aortic stenosis; is it durable? A cardiovascular MRI study sponsored by the American Heart Association.
abstract: BACKGROUND
  In patients with severe aortic stenosis (AS), long-term data tracking surgically induced effects of afterload reduction on reverse LV remodeling are not available. Echocardiographic data is available short term, but in limited fashion beyond one year. Cardiovascular MRI (CMR) offers the ability to serially track changes in LV metrics with small numbers due to its inherent high spatial resolution and low variability.
  
  
  OBJECTIVE
  We hypothesize that changes in LV structure and function following aortic valve replacement (AVR) are detectable by CMR and once triggered by AVR, continue for an extended period.
  
  
  METHODS
  Twenty-four patients of which ten (67 ± 12 years, 6 female) with severe, but compensated AS underwent CMR pre-AVR, 6 months, 1 year and up to 4 years post-AVR. 3D LV mass index, volumetrics, LV geometry, and EF were measured.
  
  
  RESULTS
  All patients survived AVR and underwent CMR 4 serial CMR's. LVMI markedly decreased by 6 months (157 ± 42 to 134 ± 32 g/m2, p < 0.005) and continued trending downwards through 4 years (127 ± 32 g/m2). Similarly, EF increased pre to post-AVR (55 ± 22 to 65 ± 11%,(p < 0.05)) and continued trending upwards, remaining stable through years 1-4 (66 ± 11 vs. 65 ± 9%). LVEDVI, initially high pre-AVR, decreased post-AVR (83 ± 30 to 68 ± 11 ml/m2, p < 0.05) trending even lower by year 4 (66 ± 10 ml/m2). LV stroke volume increased rapidly from pre to post-AVR (40 ± 11 to 44 ± 7 ml, p < 0.05) continuing to increase non-significantly through 4 years (49 ± 14 ml) with these LV metrics paralleling improvements in NYHA. However, LVmass/volume, a 3D measure of LV geometry, remained unchanged over 4 years.
  
  
  CONCLUSIONS
  After initial beneficial effects imparted by AVR in severe AS patients, there are, as expected, marked improvements in LV reverse remodeling. Via CMR, surgically induced benefits to LV structure and function are durable and, unexpectedly express continued, albeit markedly incomplete improvement through 4 years post-AVR concordant with sustained improved clinical status. This supports down-regulation of both mRNA and MMP activity acutely with robust suppression long term.
authors.affiliation: Center for Cardiovascular Magnetic Resonance Imaging, The Gerald McGinnis Cardiovascular Institute, Department of Medicine, Division of Cardiology, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, USA. rbiederm@wpahs.org
authors.forename: Robert W W
authors.initials: RW
authors.lastname: Biederman
authors.forename: James A
authors.initials: JA
authors.lastname: Magovern
authors.forename: Saundra B
authors.initials: SB
authors.lastname: Grant
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Williams
authors.forename: June A
authors.initials: JA
authors.lastname: Yamrozik
authors.forename: Diane A
authors.initials: DA
authors.lastname: Vido
authors.forename: Vikas K
authors.initials: VK
authors.lastname: Rathi
authors.forename: Geetha
authors.initials: G
authors.lastname: Rayarao
authors.forename: Ketheswaram
authors.initials: K
authors.lastname: Caruppannan
authors.forename: Mark
authors.initials: M
authors.lastname: Doyle
mesh_terms: D000368:Aged; D000572:American Heart Association; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000033:anatomy & histology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling