射血分数
医学
心脏病学
内科学
主动脉瓣置换术
狭窄
反流(循环)
主动脉瓣
临床终点
主动脉瓣狭窄
心力衰竭
随机对照试验
作者
Yoshifumi Saijo,Tom Kai Ming Wang,Nicolás Isaza,Julijana Conic,Douglas R. Johnston,Eric E. Roselli,Milind Y. Desai,Richard A. Grimm,Lars G. Svensson,Samir Kapadia,Brian P. Griffin,Zoran B. Popović
摘要
Abstract Background The implications of left ventricular remodeling and dysfunction before and after aortic valve replacement (AVR) for mixed aortic valve disease (MAVD) are not well understood. This study aims to evaluate the impact of AVR on left ventricular (LV) systolic function in MAVD, and determine the prognostic value of postoperative LV global longitudinal strain (LV‐GLS) and LV ejection fraction (LVEF). Methods We retrospectively assessed 489 consecutive patients with MAVD (defined as at least moderate aortic stenosis and at least moderate aortic regurgitation) and baseline LVEF ≥50%, who underwent AVR between February 2003 and August 2018. All patients had baseline echocardiography, whereas 192 patients underwent postoperative echocardiography between 3 and 18 months after AVR. The primary endpoint was all‐cause mortality. Results Mean age was 65 ± 15 years, and 65% were male. AVR in MAVD patients has a neutral effect on LV systolic function quantitated by LVEF and LV‐GLS. During a median follow‐up period of 5.8 years, 65 patients (34%) of 192 patients with follow‐up echocardiography died. The patients with postoperative LVEF ≥50% had better survival than those with postoperative LVEF <50% ( P < .001). Furthermore, among patients with postoperative LVEF ≥50%, mortality differed between patients with postoperative LV‐GLS worse than –15% and those with postoperative LV‐GLS better than ‐15% ( P < .001). Conclusions In patients with MAVD who underwent AVR, the mean postoperative LV‐GLS and LVEF remain at a similar value to baseline. However, worse postoperative LV‐GLS and LVEF were both independently associated with higher mortality in this population.
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