European heart journal cardiovascular Imaging, Volume 20, Issue 10, 01 October 2019, Pages 1105-1111 Time course of left ventricular remodelling and mechanics after aortic valve surgery: aortic stenosis vs. aortic regurgitation. Vollema EM, Singh GK, Prihadi EA, Regeer MV, Ewe SH, Ng ACT, Mertens BJA, Klautz RJM, Ajmone Marsan N, Bax JJ, Delgado V

Aims

Pressure overload in aortic stenosis (AS) and both pressure and volume overload in aortic regurgitation (AR) induce concentric and eccentric hypertrophy, respectively. These structural changes influence left ventricular (LV) mechanics, but little is known about the time course of LV remodelling and mechanics after aortic valve surgery (AVR) and its differences in AS vs. AR. The present study aimed to characterize the time course of LV mass index (LVMI) and LV mechanics [by LV global longitudinal strain (LV GLS)] after AVR in AS vs. AR.

Methods and results

Two hundred and eleven (61 ± 14 years, 61% male) patients with severe AS (63%) or AR (37%) undergoing surgical AVR with routine echocardiographic follow-up at 1, 2, and/or 5 years were evaluated. Before AVR, LVMI was larger in AR patients compared with AS. Both groups showed moderately impaired LV GLS, but preserved LV ejection fraction. After surgery, both groups showed LV mass regression, although a more pronounced decline was seen in AR patients. Improvement in LV GLS was observed in both groups, but characterized by an initial decline in AR patients while LV GLS in AS patients remained initially stable.

Conclusion

In severe AS and AR patients undergoing AVR, LV mass regression and changes in LV GLS are similar despite different LV remodelling before AVR. In AR, relief of volume overload led to reduction in LVMI and an initial decline in LV GLS. In contrast, relief of pressure overload in AS was characterized by a stable LV GLS and more sustained LV mass regression.

Keywords: Aortic Stenosis, Aortic Regurgitation, Lv Remodelling, Lv Mechanics, Lv Global Longitudinal Strain, Lv Mass Regression

Eur Heart J Cardiovasc Imaging. 2019 Oct;20(10):1105-1111