title: Prosthesis-patient mismatch and left ventricle systolic strain in patients with severe degenerative aortic stenosis, who are undergoing surgical valve replacement.
abstract: BACKGROUND
  Prosthesis-patient mismatch (PPM) is an independent predictor of post-operative mortality after aortic valve replacement (AVR), particularly when it is associated with a left ventricle (LV) dysfunction. Two-dimensional speckle-tracking echocardiography (2D-STE) could be useful in assessing LV function in patients with PPM.
  
  
  OBJECTIVE
  To evaluate the impact of PPM on myocardial multidirectional LV systolic strain in patients who are undergoing AVR for severe degenerative aortic stenosis (AS).
  
  
  METHODS
  Sixty-five patients (38 females, 27 males, age: 69.9 ± 9.1 years) with severe degenerative AS and preserved LV ejection fraction were enrolled into the study. Pre- and three-month postoperative 2D-STE was performed to assess LV peak systolic longitudinal strain (LV PSLS), circumferential strain, and LV rotation. The indexed prosthesis effective orifice area (iEOAprosth) was used to define PPM (≤ 0.65 cm2/m2), and it was used to distinguish the study groups: PPM (+) (n = 35) and PPM (-) (n = 30).
  
  
  RESULTS
  A significant association of LV PSLS and interaction in the groups [PPM (+) vs. PPM (-)] and intervention (before vs. after AVR; p = 0.019) was observed - the lowest value of LV PSLS was in the PPM (+) group (-14.9 ± 3.5%) after AVR. A significant difference in the mean delta (before/after AVR) values of LV PSLS (0.7 ± 3.1% vs. -1.2 ± 3.6%; p = 0.04) in the PPM (+) vs. the PPM (-) groups was found. LV PSLS correlated with iEOAprosth (r = -0.520, p < 0.001) that was obtained three months after AVR.
  
  
  CONCLUSIONS
  The occurrence of PPM in patients undergoing AVR for severe degenerative AS was associated with reduced LV PSLS in a three-month observation.
authors.affiliation: 1st Department of Cardiology, Medical University of Silesia, Katowice, Poland. kmizia@op.pl.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Mizia-Stec
authors.forename: Magdalena
authors.initials: M
authors.lastname: Mizia
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sikora-Puz
authors.forename: Klaudia
authors.initials: K
authors.lastname: Gieszczyk-Strózik
authors.forename: Tomasz
authors.initials: T
authors.lastname: Bochenek
authors.forename: Bartosz
authors.initials: B
authors.lastname: Lasota
authors.forename: Artur
authors.initials: A
authors.lastname: Chmiel
authors.forename: Jerzy
authors.initials: J
authors.lastname: Chudek
authors.forename: Marek
authors.initials: M
authors.lastname: Deja
authors.forename: Edyta
authors.initials: E
authors.lastname: Płońska-Gościniak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016277:Ventricular Function, Left
keywords: NT-proBNP; aortic valve replacement; left ventricle; peak systolic longitudinal strain; prosthesis-patient mismatch