Department of Cardiovascular Medicine, Heart, Thoracic and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Thoracic and Cardiovascular Surgery, Heart, Thoracic and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Echocardiography. 2023 Apr;40(4):318-326. doi: 10.1111/echo.15544. Epub 2023 Mar 1.
The implications of left ventricular remodeling and dysfunction before and after aortic valve replacement (AVR) for mixed aortic valve disease (MAVD) are not well understood. This study aims to evaluate the impact of AVR on left ventricular (LV) systolic function in MAVD, and determine the prognostic value of postoperative LV global longitudinal strain (LV-GLS) and LV ejection fraction (LVEF).
We retrospectively assessed 489 consecutive patients with MAVD (defined as at least moderate aortic stenosis and at least moderate aortic regurgitation) and baseline LVEF ≥50%, who underwent AVR between February 2003 and August 2018. All patients had baseline echocardiography, whereas 192 patients underwent postoperative echocardiography between 3 and 18 months after AVR. The primary endpoint was all-cause mortality.
Mean age was 65 ± 15 years, and 65% were male. AVR in MAVD patients has a neutral effect on LV systolic function quantitated by LVEF and LV-GLS. During a median follow-up period of 5.8 years, 65 patients (34%) of 192 patients with follow-up echocardiography died. The patients with postoperative LVEF ≥50% had better survival than those with postoperative LVEF <50% (P < .001). Furthermore, among patients with postoperative LVEF ≥50%, mortality differed between patients with postoperative LV-GLS worse than -15% and those with postoperative LV-GLS better than -15% (P < .001).
In patients with MAVD who underwent AVR, the mean postoperative LV-GLS and LVEF remain at a similar value to baseline. However, worse postoperative LV-GLS and LVEF were both independently associated with higher mortality in this population.
主动脉瓣置换术（AVR）前后左心室重构和功能障碍对混合性主动脉瓣疾病（MAVD）的影响尚不清楚。本研究旨在评估 AVR 对 MAVD 左心室（LV）收缩功能的影响，并确定术后 LV 整体纵向应变（LV-GLS）和 LV 射血分数（LVEF）的预后价值。
我们回顾性评估了 2003 年 2 月至 2018 年 8 月期间接受 AVR 的 489 例 MAVD（定义为至少中度主动脉瓣狭窄和至少中度主动脉瓣反流）且基线 LVEF≥50%的连续患者。所有患者均行基线超声心动图检查，其中 192 例患者在 AVR 后 3 至 18 个月行术后超声心动图检查。主要终点是全因死亡率。
平均年龄为 65±15 岁，65%为男性。AVR 对 LVEF 和 LV-GLS 定量的 LV 收缩功能有中性影响。在中位随访 5.8 年期间，192 例有随访超声心动图的患者中有 65 例（34%）死亡。术后 LVEF≥50%的患者比术后 LVEF<50%的患者有更好的生存（P<0.001）。此外，在术后 LVEF≥50%的患者中，术后 LV-GLS 差于-15%和 LV-GLS 好于-15%的患者之间死亡率不同（P<0.001）。
在接受 AVR 的 MAVD 患者中，平均术后 LV-GLS 和 LVEF 仍与基线值相似。然而，较差的术后 LV-GLS 和 LVEF 与该人群的更高死亡率均独立相关。
