Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania.
Medicina (Kaunas). 2022 Oct 7;58(10):1410. doi: 10.3390/medicina58101410.
Background and Objectives: Patients with surgical aortic stenosis (AS) show impaired diastolic filling, which is a risk factor for early and late mortality after aortic valve replacement (AVR). There is a paucity of information concerning the impact of restrictive diastolic filling and the evolution of diastolic dysfunction in the early and medium terms post-AVR. We aimed to determine the prognostic value of the presence of a restrictive left-ventricular (LV) diastolic filling pattern (LVDFP) and dilated left atrium (LA) in patients with AS and LV systolic dysfunction (LVEF < 40%) who underwent AVR, and to define the independent predictors for immediate and long-term prognosis and their value for preoperative risk estimation. Materials and Methods: The study was prospective and included 197 patients with surgical AS and LVEF <40% who underwent AVR. Preoperative echocardiographic examinations were repeated at day 10, at 1, 3 and 6 months, and at 1 and 2 years after surgery, with evaluation of LVEF, diastolic function and LA dimension index (mm/m2). Depending on LV systolic performance, patients were classified as Group A (LVEF: 30−40%) or Group B (LVEF < 30%). Results: The main echographic independent parameters for early and late postoperative death were: restrictive LVDFP, significant pulmonary hypertension, LV end-systolic diameter (LVESD) >55 mm and the presence of second-degree mitral regurgitation. Restrictive LVDFP and LA dimension >30 mm/m2 were independent predictors for fatal outcome (p = 0.0017). Conclusions: Assessment of diastolic function and LA dimension are reliable parameters in predicting fatal outcome and hospitalization for heart failure, having an independent and incremental prognostic value in patients with surgical AS. Complete evaluation of LVDFP with all the echographic measurements (including TDI) should routinely be part of the preoperative assessment of patients with LV systolic dysfunction undergoing AVR.
患有外科主动脉瓣狭窄（AS）的患者表现出舒张期充盈受损，这是主动脉瓣置换（AVR）后早期和晚期死亡率的一个危险因素。关于限制性左心室（LV）舒张期充盈模式（LVDFP）和左心房（LA）扩张在 AS 合并 LV 收缩功能障碍（LVEF<40%）患者 AVR 后中短期的影响的信息很少。我们旨在确定 LVDFP 存在和 LA 扩张对接受 AVR 的 AS 合并 LV 收缩功能障碍（LVEF<40%）患者的预后价值，并确定即刻和长期预后的独立预测因素及其用于术前风险评估的价值。
该研究为前瞻性研究，共纳入 197 例接受 AVR 的外科 AS 合并 LVEF<40%的患者。术前超声心动图检查在术后第 10 天、第 1、3 和 6 个月以及第 1 和 2 年重复进行，评估 LVEF、舒张功能和 LA 内径指数（mm/m2）。根据 LV 收缩功能，患者被分为 A 组（LVEF：30-40%）或 B 组（LVEF<30%）。
早期和晚期术后死亡的主要超声独立参数是：限制性 LVDFP、显著肺动脉高压、LV 收缩末期直径（LVESD）>55mm 和存在二尖瓣反流 2 度。限制性 LVDFP 和 LA 内径>30mm/m2 是死亡结局的独立预测因素（p=0.0017）。
舒张功能和 LA 内径评估是预测致命结局和心力衰竭住院的可靠参数，在外科 AS 患者中具有独立的、递增的预后价值。LVDFP 的全面评估应包括所有超声测量（包括 TDI），应常规作为接受 AVR 的 LV 收缩功能障碍患者术前评估的一部分。
