Hatani Takeshi, Kitai Takeshi, Murai Ryosuke, Kim Kitae, Ehara Natsuhiko, Kobori Atsushi, Kinoshita Makoto, Kaji Shuichiro, Tani Tomoko, Sasaki Yasuhiro, Yamane Takafumi, Koyama Tadaaki, Nasu Michihiro, Okada Yukikatsu, Furukawa Yutaka
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Institute of Biomedical Research and Innovation, Kobe, Japan.
J Cardiol. 2016 Sep;68(3):241-7. doi: 10.1016/j.jjcc.2015.09.017. Epub 2015 Oct 31.
Aortic valve replacement (AVR) is currently the standard therapy for severe aortic stenosis (AS), and regression of left ventricular (LV) hypertrophy after AVR has been reported. However, data regarding a temporal relation between LV mass and left atrial (LA) volume are limited, and their prognostic impacts have not been fully elucidated. We aimed to clarify the temporal patterns of LA and LV reverse remodeling and their associations with clinical outcomes.
We retrospectively reviewed 198 consecutive patients who underwent AVR for severe AS. After excluding patients with prior cardiac surgery, atrial fibrillation, concomitant moderate to severe aortic regurgitation, or concurrent mitral valve surgery, 83 patients with echocardiographic LV mass index (LVMI) and LA volume index (LAVI) data before and 1 year after AVR were eligible for the outcome analysis and 29 patients with these 2 measures before surgery, 1 month, 1 year, and 3 years after surgery were eligible for the analysis of time-dependent change of LVMI and LAVI.
Significant reductions in LVMI and LAVI (both p<0.001) after surgery were observed over time. LA dilatation improved and reached a plateau 1 month after surgery, whereas LV hypertrophy improved more gradually and reached a plateau at 1 year. The presence of both LV hypertrophy and LA dilatation 1 year after surgery was associated with significantly higher mortality (patients with both conditions vs. patients with neither or one condition=22.6% vs. 7.3% at 3 years; p=0.031) and major adverse cardiac and cerebrovascular events (38.9% vs. 12.6% at 3 years; p=0.021).
LA reverse remodeling occurred rapidly after AVR for severe AS, and regression of LV hypertrophy was more gradual. The presence of both residual LV hypertrophy and LA dilatation 1 year after AVR was associated with poor long-term outcomes.
主动脉瓣置换术（AVR）是目前重度主动脉瓣狭窄（AS）的标准治疗方法，且已有报道称AVR术后左心室（LV）肥厚会消退。然而，关于LV质量与左心房（LA）容积之间时间关系的数据有限，其预后影响尚未完全阐明。我们旨在明确LA和LV逆向重构的时间模式及其与临床结局的关联。
我们回顾性分析了198例因重度AS接受AVR的连续患者。排除既往有心脏手术史、心房颤动、合并中度至重度主动脉瓣反流或同期二尖瓣手术的患者后，83例术前及AVR术后1年有超声心动图LV质量指数（LVMI）和LA容积指数（LAVI）数据的患者符合结局分析条件，29例术前、术后1个月、1年和3年有这两项测量值的患者符合LVMI和LAVI时间依赖性变化分析条件。
术后随时间推移，LVMI和LAVI均显著降低（均p<0.001）。LA扩张在术后1个月改善并达到平台期，而LV肥厚改善较为缓慢，在1年时达到平台期。术后1年同时存在LV肥厚和LA扩张与显著更高的死亡率（3年时，两种情况均有的患者与两种情况均无或仅有一种情况的患者相比为22.6%对7.3%；p=0.031）及主要不良心脑血管事件（3年时为38.9%对12.6%；p=0.021）相关。
重度AS患者AVR术后LA逆向重构迅速发生，LV肥厚的消退较为缓慢。AVR术后1年仍存在残余LV肥厚和LA扩张与不良长期结局相关。
