Abstract 15988: S-wave as a Sensitive Measurement of Left Ventricular Dysfunction in Pre-operative Aortic Insufficiency Evaluation
Introduction: Optimal timing for aortic valve replacement (AVR) in severe aortic insufficiency (AI) is still debated. Guidelines underline left ventricular dysfunction as documented by ejection fraction (LVEF) for Class-I indication for surgery. Yet, LVEF shows lack of sensibility to detect myocardial impairment. We thus aimed to identify independent predictors of post-operative decrease in LVEF.
Methods: 99 patients with preserved LVEF (≥50%) underwent AVR for pure moderate to severe AI as primary surgical indication. All patients had comprehensive pre- and immediate post-operative transthoracic echocardiographic exams. LVEF was measured by Simpson’s biplane method. We excluded patients with history of or active endocarditis and ascending aorta replacement as primary surgical indication.
Results: Mean age at time of surgery was 56±14years and 91% were men. 27% of patients underwent concomitant coronary artery bypass grafting (CABG). After surgery, 31 patients presented decreased LVEF (<50%). A background model was built including age, sex, systolic blood pressure, LV end-systolic diameter (LVESd), pre-operative LVEF and AI severity. The independent predictors of reduced EF after surgery were LVESd (p=0.05) and AI severity (p=0.005). LVEF was not associated with reduced post-operative LVEF (p=0.97). Adding tissue-Doppler S-wave in the background model increased predictive value (likelihood ratio p=0.016) and reclassified 76% of patients (by net reclassification index method, p=0.01). S-wave as a continuous variable was an independent predictor of reduced LVEF post-operatively (p=0.05). Having an S-wave ≤8cm/s significantly increased the risk of reducing LVEF after surgery (OR=53; p=0.0008). CABG was not associated (p=0.60) with decreased post-operative LVEF and did not modify previous results.
Conclusions: In this surgical series of pure AI patients, tissue-Doppler S-wave was better than LVEF to predict reduced post-operative LVEF and added predicted value. Tissue-Doppler should thus be integrated in clinical decision making process for surgery referral in patients with preserved LVEF and moderate to severe AI.
Author Disclosures: L. Simard: None. F. Dagenais: None. L. Tastet: None. M. Clavel: None.
- © 2016 by American Heart Association, Inc.