Cardiac Surgery Department, University of Rome La Sapienza, Policlinico S. Andrea, Via di Grottarossa 1039 Rome, Italy.
J Thorac Cardiovasc Surg. 2010 Apr;139(4):881-6. doi: 10.1016/j.jtcvs.2009.05.041.
Left ventricular hypertrophy regression is assumed to be one of the most important goals after aortic valve replacement for aortic stenosis. A moderate decrease in the glomerular filtration rate is associated with a significantly increased risk of left ventricular hypertrophy in hypertensive patients. The effect of moderate kidney disease on left ventricular hypertrophic remodeling in other conditions of chronic left ventricular pressure overload, such as aortic stenosis, remains unknown. Therefore we tested the hypothesis that moderate chronic kidney disease affects left ventricular mass regression in patients undergoing isolated aortic valve replacement for aortic stenosis.
In 157 patients with aortic stenosis, left ventricular mass regression was assessed at 18 months after aortic valve replacement. Among them, 73 (46%) had a moderate chronic kidney disease (glomerular filtration rate between 60 and 30 mL/min per 1.73 m(2)). Patients with severely impaired kidney function (glomerular filtration rate of <30 mL/min per 1.73 m(2)) were excluded.
After surgical intervention, left ventricular mass was significantly lower from baseline value in both groups, but patients with moderate chronic kidney disease continued to show an increased left ventricular mass (61 +/- 18 vs 50 +/- 16 g/m(2.7), P = .0001). The baseline glomerular filtration rate was significantly related to left ventricular mass at 18 months after surgical intervention (beta = -0.17, r(2) = 0.45, P = .01) and left ventricular mass absolute (beta = 0.18, r(2) = 0.19, P = .03) and relative (beta = 0.20, r(2) = 0.21, P = .02) regression. These associations persisted after adjusting for confounding factors, including hypertension and patient-prosthesis mismatch. After a mean time of 34 +/- 12 months from surgical intervention, congestive heart failure symptoms developed mainly in subjects with moderate chronic kidney disease (adjusted hazard ratio, 1.9; 95% confidence interval, 1.2-3.9; P = .035).
Patients with aortic stenosis with concomitant moderate chronic kidney disease present a less evident left ventricular mass regression after aortic valve replacement. Moreover, this condition is related to an increased occurrence of congestive heart failure after surgical intervention.
左心室肥厚的消退被认为是主动脉瓣狭窄患者主动脉瓣置换术后的最重要目标之一。在高血压患者中，肾小球滤过率的适度下降与左心室肥厚的风险显著增加相关。在慢性左心室压力超负荷的其他情况下，如主动脉瓣狭窄，中度肾病对左心室肥厚重塑的影响尚不清楚。因此，我们测试了这样一个假设，即中度慢性肾病会影响接受主动脉瓣置换术的主动脉瓣狭窄患者的左心室质量消退。
在 157 例主动脉瓣狭窄患者中，在主动脉瓣置换术后 18 个月评估左心室质量消退。其中，73 例（46%）患有中度慢性肾病（肾小球滤过率在 60 至 30ml/min/每 1.73m2 之间）。排除严重肾功能障碍（肾小球滤过率<30ml/min/每 1.73m2）的患者。
手术后，两组患者的左心室质量均较基线值显著降低，但中度慢性肾病患者的左心室质量仍持续增加（61 ± 18 比 50 ± 16g/m2.7，P=0.0001）。基线肾小球滤过率与手术后 18 个月的左心室质量显著相关（β=-0.17，r2=0.45，P=0.01），与左心室质量绝对值（β=0.18，r2=0.19，P=0.03）和相对值（β=0.20，r2=0.21，P=0.02）的回归相关。这些相关性在调整混杂因素（包括高血压和患者-假体不匹配）后仍然存在。在手术后平均 34 ± 12 个月后，充血性心力衰竭症状主要发生在中度慢性肾病患者中（调整后的危险比，1.9；95%置信区间，1.2-3.9；P=0.035）。
患有主动脉瓣狭窄合并中度慢性肾病的患者，在主动脉瓣置换术后，左心室质量消退不太明显。此外，这种情况与手术后充血性心力衰竭的发生增加有关。
