title: Relevance of residual left ventricular hypertrophy after surgery for isolated aortic stenosis.
abstract: OBJECTIVE
  Persistent left ventricular (LV) hypertrophy after surgery is frequent, but its clinical relevance is controversial. We evaluated if residual LV hypertrophy (LVH) is associated with clinical outcomes after aortic valve replacement (AVR) for severe aortic stenosis (AS).
  
  
  METHODS
  We analysed clinical and echocardiographic parameters before and after AVR, in a prospective cohort of 132 patients with severe AS. The mean follow-up was 6.0 ± 1.5 years. Clinical endpoints were all-cause death and combination of as in all-cause death and non-fatal cardiovascular hospitalization. At AVR, myocardial biopsies for collagen volume fraction (CVF) evaluation were done in 56 random patients.
  
  
  RESULTS
  Residual LVH was present in 44% of patients after AVR. Patients with residual LVH were older, more frequently women and had hypertension (HT). Preoperatively, they had higher LV mass indices (LVMI), higher E/e' and left atrial volume indices, as well as lower peak systolic annular velocity. Female gender, HT, LVMI and E/e' were independent predictors of persistent LVH. CVF at the time of surgery was higher in those with residual LVH (20.0 ± 14.6 vs 13.2 ± 11.5%, P = 0.027). The risk of all-cause death and non-fatal cardiovascular hospitalization was higher in patients with residual LVH [OR 2.89 (95% CI 1.12-7.44); P = 0.035], but there were no differences in all-cause mortality. Residual LVH was associated with a worse outcome in women but not in men.
  
  
  CONCLUSIONS
  Residual LVH after AVR is common and is associated with worse prognosis, particularly in women. In addition, HT, higher baseline LVM and worse diastolic dysfunction can help to identify patients at risk for incomplete normalization of LVM.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal cristina.gavina@gmail.com.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gavina
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Falcão-Pires
authors.affiliation: Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Pinho
authors.affiliation: Department of Biostatistics, Faculty of Health Sciences, University Fernando Pessoa - CIAGEB-UFP, Porto, Portugal REQUIMTE, University of Porto, Porto, Portugal.
authors.forename: Maria-Conceição
authors.initials: MC
authors.lastname: Manso
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gonçalves
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rocha-Gonçalves
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Adelino
authors.initials: A
authors.lastname: Leite-Moreira
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020257:Ventricular Remodeling
keywords: Aortic stenosis; Aortic valve replacement; Hypertrophy; Left ventricular remodelling; Myocardial fibrosis