title: Myocardial metabolism and diastolic function after aortic valve replacement for aortic stenosis: influence of patient-prosthesis mismatch.
abstract: OBJECTIVE
  This study evaluated the impact of patient-prosthesis mismatch on myocardial function and high-energy phosphate metabolism after aortic valve replacement for pure aortic stenosis. Patients with and without patient-prosthesis mismatch were compared using magnetic resonance techniques.
  
  
  METHODS
  Thirty patients who had undergone aortic valve replacement with Medtronic Mosaic bioprosthesis were evaluated. Fifteen patients with patient-prosthesis mismatch were compared to 15 matched patients without patient-prosthesis mismatch. These two homogeneous groups were studied for myocardial metabolism and left ventricle function preoperatively and at 12 months postoperatively with magnetic resonance imaging and (31)P spectroscopy.
  
  
  RESULTS
  All patients experienced improvement in myocardial metabolism and left ventricle function. Left ventricle mass regression was impaired in both groups. Impaired diastolic filling was associated with increased left ventricle wall mass in both groups (patient-prosthesis mismatch: R(2) = -0.71, p = 0.002; no patient-prosthesis mismatch: R(2) = -0.88, p < 0.001). Myocardial phosphocreatine/adenosine triphosphate ratio revealed a modest correlation with left ventricle function as evaluated by early acceleration peak (patient-prosthesis mismatch: R(2) = 0.37, p = 0.03; no patient-prosthesis mismatch: R(2) = 0.17, p = 0.02) and early deceleration peak (patient-prosthesis mismatch: R(2) = 0.30, p = 0.01; no patient-prosthesis mismatch: R(2) = 0.39, p = 0.008). No significant correlation between the phosphocreatine/adenosine triphosphate ratio and left ventricle mass was found (patient-prosthesis mismatch: R(2) = 0.39, p = 0.6; no patient-prosthesis mismatch: R(2) = 0.40, p = 0.08).
  
  
  CONCLUSIONS
  Aortic valve replacement leads to early improvement of left ventricle function and myocardial metabolism in all patients regardless of the occurrence of patient-prosthesis mismatch.
authors: Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy. vitomannacio2@libero.it
authors: Vito
authors: V
authors: Mannacio
authors: Luigi
authors: L
authors: Di Tommaso
authors: Paolo
authors: P
authors: Stassano
authors: Vincenzo
authors: V
authors: De Amicis
authors: Carlo
authors: C
authors: Vosa
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D003971:Diastole / Q000502:physiology; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D010710:Phosphates / Q000378:metabolism; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D010710:Phosphates