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Cited by 120Cardiac Valve Diseases and TreatmentsAortic Disease and Treatment ApproachesCongenital Heart Disease Studies

Influence of Concentric Left Ventricular Remodeling on Early Mortality After Aortic Valve Replacement

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Duncan, Andra Ibrahim, Lowe, Boris S., Garcia, Mario J., Xu, Meng, Gillinov, A. Marc, Mihaljevic, Tomislav, Koch, Colleen G.·2008·The Annals of Thoracic Surgery
DOI 10.1016/j.athoracsur.2008.02.075
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Abstract

Background Severe left ventricular (LV) hypertrophy increases risk for adverse outcome after aortic valve replacement. Whether LV geometry influences mortality risk after aortic valve replacement is unclear. And, whether LV mass or relative wall thickness (RWT) better predicts risk for adverse postoperative outcomes is unknown. The purpose of this investigation was to examine the influence of LV geometry and LV hypertrophy on morbidity and in-hospital mortality after aortic valve replacement, and to determine whether LV mass or RWT had better prognostic ability.Methods Between January 1996 and June 2004, 5,083 patients underwent aortic valve replacement. Preoperative echocardiographic data was used to calculate LV mass and RWT. Left ventricular geometry was classified into one of four categories on the basis of LV mass indexed to body height and RWT: (1) concentric hypertrophy, (2) eccentric hypertrophy, (3) concentric remodeling, and (4) normal. Postoperative mortality and multisystem morbidities of patients with concentric geometries were compared to patients with nonconcentric geometries by propensity and logistic regression modeling. Also, prognostic ability of RWT and LV mass was compared.Results Nine hundred sixty-four patients with concentric geometry were propensity-matched to 964 patients with nonconcentric geometry. In-hospital mortality (38 [3.9%] versus 18 [1.9%]; p = 0.007), cardiac morbidity (33 [3.4%] versus 17 [1.8%]; p = 0.022), and prolonged intubation (85 [8.8%] versus 58 [6.0%]; p = 0.019) were higher in patients with concentric versus nonconcentric geometry. Increasing RWT, not LV mass, was associated with adverse outcomes.Conclusions Concentric geometries are associated with increased risk for in-hospital mortality after aortic valve replacement. Increased RWT is associated with adverse outcomes. Preoperative risk stratification should include assessments of LV hypertrophy and LV geometry.

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  • In calcific AS, LV concentric remodelling or hypertrophy is linked to worse myocardial function and higher risk of cardiac events and mortality than normal LV geometry or eccentric hypertrophy.

    “In patients with calcific AS, LV concentric remodelling or hypertrophy has been linked to worse myocardial function and increased risk of cardiac events and mortality compared to patients with normal LV geometry or with LV eccentric hypertrophy120–122.”

    From Calcific aortic stenosis (2016) · cites this paper as [122]

    The Outcomes: Propensity-Matched Patients section (page unavailable) reports higher early postoperative mortality and cardiac morbidity with concentric than nonconcentric geometry, including higher mortality than with eccentric hypertrophy. The study did not isolate patients with calcific aortic stenosis, and comparisons with normal geometry were not statistically significant. Its baseline description says patients with concentric geometry had better-preserved LV function, although the Comment discusses possible diastolic dysfunction; it therefore does not establish worse myocardial function as claimed. (LLM, conf=0.88)

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  1. [23]23. Antonini-Canterin F, Huang G, Cervesato E, et al. Symptom- atic aortic stenosis: does systemic hypertension play an additional role? Hypertension 2003;41:1268 -72.

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Authors
Duncan, A. I., Lowe, B. S., Garcia, M. J., Xu, M., Gillinov, A. M., Mihaljevic, T., & Koch, C. G.
Affiliations
  • Cleveland Clinic (US)
  • Icahn School of Medicine at Mount Sinai (US)
Corresponding author
Duncan, Andra Ibrahim
ORCID
Venue
The Annals of Thoracic Surgery
Publisher
Elsevier BV
Published
2008-06
Volume
85
Issue
6
Pages
2030-2039
ISSN
0003-4975 (ISSN-L)
DOI
10.1016/j.athoracsur.2008.02.075
OpenAlex
W2155083218
Cited by
120
References
32
Citations by year
2026: 1 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 8 · 2020: 9 · 2019: 12 · 2018: 8 · 2017: 8 · 2016: 6 · 2015: 13 · 2014: 11 · 2013: 8 · 2012: 6
FWCI
3.15
Type
journal article
Language
en
Open access
Licence
Locations
  • The Annals of Thoracic Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
Keywords
aortic valve replacement, left ventricular remodeling, concentric hypertrophy, left ventricular hypertrophy, left ventricular mass, relative wall thickness, left ventricular geometry, in-hospital mortality, postoperative morbidity, prolonged intubation, preoperative risk stratification, prognosis
MeSH terms
Aged, Aortic Valve Stenosis, Cardiac Output, Low, Cause of Death, Echocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction, Postoperative Complications, Prognosis, Risk Factors, Hospital Mortality, Hypertrophy, Left Ventricular, Echocardiography, Doppler, Color, Heart Valve Prosthesis Implantation, Ventricular Remodeling

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