N.V. Ponych, O.J. Zharinov, O.A. Yepanchintseva, B.M. Todurov Recovery of left ventricular ejection fraction in patients with aortic stenosis and systolic left ventricular dysfunction after aortic valve replacement

The aim – to evaluate clinical and echocardiographic predictors of the improvement of cardiac systolic function in patients with aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) after aortic valve replacement (AVR).

Material and methods. The one-center study analyzed data received from 49 patients with severe aortic stenosis (AS) and left ventricular systolic dysfunction (ejection fraction – LVEF less than 45 %), consecutively selected for isolated aortic valve replacement (AVR). The median age was 60 (lower-upper quartile 53–65) years. Before surgery all patients underwent transthoracic echocardiography (TTE) and coronary angiography. At 6 months after surgery TTE was performed in 48 patients; one patient died during the observation period. Uni- and multivariate logistic regression analyses were performed to identify factors independently associated with most notable increase of LVEF.

Results. Six months after AVR, significant decrease of left ventricular (LV) and left atrial volumes, free ventricular wall thickness and left ventricular mass index was noted, along with improvement of LVEF, other indicators of ventricular contractility (MAPSE, index Tei, wave s) and left ventricular diastolic function parameters. Recovery of LVEF was independent of age, sex, body mass index, heart rate and prevalent concomitant diseases, including arterial hypertension, atrial fibrillation and congestive heart failure. Initial LVEF was the strongest independent predictor of LVEF recovery (β=–0.87; Р<0,001). Mean pressure gradient on aortic valve, tricuspid insufficiency, mitral insufficiency, left ventricular end-diastolic volume index, e′ mean velocity of the mitral valve ring and concomitant diabetes mellitus appeared independently associated with improvement of LVEF as well, with less strength of the relation. Conclusions. Initially low LVEF is the strongest predictor of the significant improvement of left ventricular structure and function in patients with severe AS six months after AVR. AVR is reasonable in patients with AS and a reduced LVEF, having no significant contraindications for cardiac surgery.

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