Abstract 3170: Noninvasive Estimate of Left Ventricular Filling Pressure (E/E′) is a Major Determinant of Early and Midterm Postoperative Cardiovascular Events After Isolated Aortic Valve Replacement in Patients With Severe Aortic Stenosis
Background- Left ventricular (LV) filling pressure is commonly elevated in severe aortic stenosis (AS) patients and associated with dyspnea. However, early and midterm postoperative outcome after aortic valve replacement (AVR) in severe AS patients with elevated diastolic filling pressure is rarely reported. We investigated whether preoperative estimated LV filling pressure predicts the postoperative outcome in patients with severe AS.
Methods and Results - Two hundred and ten patients who underwent isolated AVR due to severe AS were analyzed. LV filling pressure was noninvasively assessed by E/E′ which was calculated from mitral inflow and mitral annulus tissue Doppler. Early postoperative outcomes including ventilator time, intensive care unit stay, inotropics support, and hospital stay were reviewed. Postoperative mortality and morbidity was searched and compared according to LV filling pressure. Preoperative functional class was associated with elevated E/E′. E/E′, LV ejection fraction, and age were associated with postoperative hospital course. E/E′ was the major determinant of postoperative hospital stay (stay in intensive care units, ventilator support, and hospital stay) in multivariate analysis. Midterm mortality of overall population was very low after AVR (2%). Cardiovascular event free survival including hospital visit due to heart failure symptom, embolic infarction, and sudden cardiac death was significantly higher in the patients with elevated LV filling pressure with E/E′>12 (P=0.03). Furthermore, among the patients with preserved LV ejection fraction (EF>50%), this relationship persisted. Multivariate analysis showed a high hazard ratio of elevated E/E′>12 (HR=41, P<0.001).
Conclusions - Postoperative mortality of isolated AVR due to severe AS is very small in current era. E/E′ representing diastolic filling pressure is the most important determinant of early postoperative hospital course and postoperative morbidity. LV filling pressure should be considered as a predictor of the postoperative life-quality of severe AS patients.