title: Ventricular hypertrophy and left atrial dilatation persist and are associated with reduced survival after valve replacement for aortic stenosis.
abstract: OBJECTIVE
  We sought to understand the factors modulating left heart reverse remodeling after aortic valve replacement, the relationship between the preoperative symptoms and modulators of left heart remodeling, and their influence on long-term survival.
  
  
  METHODS
  From October 1991 to January 2008, 4264 patients underwent primary aortic valve replacement for aortic stenosis. Changes in the time course of left ventricular reverse remodeling were assessed using 5740 postoperative transthoracic echocardiograms from 3841 patients.
  
  
  RESULTS
  Left ventricular hypertrophy rapidly declined after surgery, from 137 ± 42 g/m(2) preoperatively to 115 ± 27 by 2 years and remained relatively constant but greater than the upper limit of normal. The most important risk factor for residual left ventricular hypertrophy was greater preoperative left ventricular hypertrophy (P < .0001). Other factors included a greater left atrial diameter (reflecting diastolic dysfunction), a lower ejection fraction, and male gender. An increased postoperative transprosthesis gradient was associated with greater residual left ventricular hypertrophy; however, its effect was minimal. Preoperative severe left ventricular hypertrophy and left atrial dilatation reduced long-term survival, independent of symptom status.
  
  
  CONCLUSIONS
  Severe left ventricular hypertrophy with left atrial dilatation can develop from severe aortic stenosis, even without symptoms. These changes can persist, are associated with decreased long-term survival even after successful aortic valve replacement, and could be indications for early aortic valve replacement if supported by findings from an appropriate prospective study.
authors: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors: Jocelyn M
authors: JM
authors: Beach
authors: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. Electronic address: mihaljt@ccaduae.ae.
authors: Tomislav
authors: T
authors: Mihaljevic
authors: Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: Jeevanantham
authors: J
authors: Rajeswaran
authors: Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: Thomas
authors: T
authors: Marwick
authors: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors: Samuel T
authors: ST
authors: Edwards
authors: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: Edward R
authors: ER
authors: Nowicki
authors: Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: James
authors: J
authors: Thomas
authors: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: Lars G
authors: LG
authors: Svensson
authors: Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: Brian
authors: B
authors: Griffin
authors: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: A Marc
authors: AM
authors: Gillinov
authors: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: Eugene H
authors: EH
authors: Blackstone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004108:Dilatation, Pathologic; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017711:Nonlinear Dynamics; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: 18; AV; AV replacement; AVR; LA; LV; LV ejection fraction; LV mass index; LVEF; LVMI; TTE; aortic valve; left atrial; left ventricular; transthoracic echocardiogram