Abstract 3684: Don’t Wait for Symptoms! Watch the Ventricle: Residual Hypertrophy After Aortic Valve Replacement
Background: Severity of left ventricular (LV) remodeling is among the preoperative factors determining survival after aortic valve replacement (AVR) for aortic stenosis (AS). Our objectives were to determine the time course and modulators of LV reverse remodeling to define timing of AVR better than current symptom-based guidelines.
Methods: From 1991 to 2008, 4,264 patients underwent primary AVR for AS. Temporal trend in LV mass index (LVMI) was assessed using 5,740 post-AVR transthoracic echocardiograms.
Results: LVMI fell sharply from 142±42 g•m−2 pre-AVR to 115±27 by 2 years, then gradually increased to 119±18 by 10 years (figure⇓). Risk factors for greater post-AVR LVMI included greater pre-AVR LMVI (P<<med>.0001; figure⇓) and lower ejection fraction (EF; P<<med>.0001). Although the greatest decrease in LVMI occurred in patients with greatest pre-AVR LVMI and lowest EF, these patients had more residual hypertrophy, as did patients with larger pre-AVR left atrial size, reflecting LV diastolic stiffness (P=.04), and higher persistent post-AVR peak LV outflow tract gradient.
Conclusions: LV remodeling, a consequence of AS, incompletely reverses after successful AVR. Residual hypertrophy is determined by severity of pre-AVR remodeling, even in patients with timely AVR by current symptom-based guidelines. Thus, intervention, even in the absence of symptoms, should be considered before severe hypertrophy develops.