Abstract 11220: Global Left Ventricular Afterload as an Important Determinant of Left Ventricular Hypertrophy in Patients with Aortic Stenosis
Background: We sought to test the hemodynamic significance of global left ventricular (LV) afterload reflecting combined valvular and arterial resistance to LV ejection in patients with aortic stenosis (AS) requiring aortic valve replacement (AVR).
Methods: The study cohort included 453 consecutive patients (247 males; mean age, 63.9±10.9 years) who underwent uneventful retrospectively analyzed including LV mass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LV hypertrophy and an index of valvular-arterial impedance ([systolic arterial pressure+transvalvular pressure gradient at pressure recovery]/stroke volume index, ZVA).
Results: Pre-AVR LVMI/LVEDVI was 2.7±0.9 g/ml with aortic valve area (AVA) of 0.6±0.2 cm2. Maximal velocity (Vmax) and mean pressure gradient (PG) was 5.0±0.7 m/s and 63±19 mmHg, respectively. ZVA was 5.9±1.9 mmHg/ml/m2. ZVA showed stronger correlation (β=0.601, p<0.001) with pre-AVR LVMI/LVEDVI than conventional hemodynamic markers including indexed AVA (β=0.061, p=0.192), Vmax (β=0.211, p<0.001) and mean PG (β=0.194, p<0.001). Post-AVR echocardiography showed that the average regression rate of LVMI/LVEDVI was 8%. ZVA was the only determinant of pre-AVR LVMI/LVEDVI (β=0.621, p<0.001) and regression of LVMI/LVEDVI (β=-0.364, p<0.001) in multivariate analysis.
Conclusion: ZVA is an important determinant of concentrical remodeling in AS and predictor of LV mass regression after AVR.
- © 2011 by American Heart Association, Inc.