CC Cardiol Croat Cardiologia Croatica Cardiol. Croat. 1848-543X 1848-5448 Croatian Cardiac Society CC 2024 19_11-12_456-7 10.15836/ccar2024.456 Extended Abstract Valvular heart disease Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery https://orcid.org/0000-0003-1542-2890BrestovacMarija1* https://orcid.org/0000-0003-1134-4856GlavašBlanka1 https://orcid.org/0000-0002-7349-6137Jakšić JurinjakSandra1 https://orcid.org/0000-0002-4721-3236Rešković LukšićVlatka12 https://orcid.org/0000-0001-8446-6120Lovrić BenčićMartina12 https://orcid.org/0000-0002-3197-2190PašalićMarijan1 https://orcid.org/0000-0002-3437-6407Šeparović HanževačkiJadranka12 University Hospital Centre Zagreb, Zagreb, Croatia University of Zagreb, School of Medicine, Zagreb, Croatia ADDRESS FOR CORRESPONDENCE: Marija Brestovac, Klinički bolnički centar Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia. / Phone: +385-99-7742-627 / E-mail: marija.brestovac@gmail.com 112024 112024 19 11-12 456 457 13102024 31102024 Croatian Cardiac Society 2024 Croatian Cardiac Society KEYWORDS: aortic regurgitationleft ventricle remodelingtiming for aortic valve replacement

Introduction: Significant aortic regurgitation (sAR) results in left ventricle (LV) remodeling and LV dysfunction due to chronic pressure and a volume overload. Timing of surgical intervention is defined by left ventricle ejection fraction (LVEF) <50% and end-systolic diameter (LVIDs) > 50 mm. (1, 2) The aim of this study was to investigate if there is difference in LV positive remodeling after AV surgery, according to LVEF above cut of value (EF>50%) at the timing of surgery.

Patients and Methods: We retrospectively analyzed echocardiographic (ECHO) database for 52 patients (pt) who underwent aortic valve surgery (AVR) from January 2017 to April 2021 due to sAR, in UHC Zagreb. Preoperative ECHO data as well as during follow-up (FU) were analyzed. The study population was divided in three groups according to initial LVEF values: group (I) included 17 pt with EF>60% (mean age 54+/-9.4), group (II) 16 pt with EF 50-60% (mean age 52+/-15.7) and group (III) 19 pt with EF<50% (mean age 60+/-6.3). ECHO parameters of LV remodeling; end-diastolic volume (EDV, ml), end-systolic volume (ESV, ml), myocardial mass (MM, g/m2) and left ventricular internal dimension at end-systole (LVIDs, mm) were compared prior surgery and in the mean FU time of 38 months.

Results: The change in absolute values of ECHO parameters and their calculated mean change are shown in (Figure 1) and (Table 1). Preoperatively, group III revealed the highest EDV/ESV/LVIDs values 259.18/148.6/51 compared to group I and II (186.11/76.83/39.6 vs. 182.21/86.8/40.2). During FU after AVR, no difference in reduction in EDV and MM (EDV p=0.115, MM p=0.774) was noticed between the 3 groups, while absolute values almost reached normal ranges only in group I and II (EDV 138.7 in I and 138.8 in II). Importantly, normalization of ESV and LVIDs during FU was shown only in group I and II, while rate of change was highest in group III (ΔESV 40.3, ΔLVIDs 13.5), LVIDs decreased more in more dilated LV (p=0.006) and even though ESV reduced in all three groups, in group III it remained enlarged (p=0.006), as expected.

Change in absolute values of end-diastolic volume, end-systolic volume, myocardial mass, and left ventricular internal dimension at end-systole after aortic valve surgery in patients surgically treated due to significant aortic regurgitation.

 Absolute values and calculated change in end-diastolic volume, end-systolic volume, myocardial mass, and left ventricular internal dimension at end-systole in 3 patient groups divided according to ejection fraction prior to aortic valve surgery due to aortic regurgitation.
Group p
EF>60% 50%<EF<60% EF<50%
Mean Standard Deviation Mean Standard Deviation Mean Standard Deviation
EDV pre 186.11 62.46 182.21 52.65 259.18 87.95 0.002
EDV post 138.74 59.56 138.88 50.30 174.55 61.26 0.101
EDV delta 44.94 55.13 40.25 63.69 80.74 81.31 0.115
ESV pre 76.83 24.71 86.84 28.39 148.59 50.02 0.000
ESV post 69.74 38.89 66.81 22.05 105.75 53.67 0.018
ESV delta 8.47 35.10 20.63 34.26 40.37 42.92 0.006
MM pre 170.76 58.20 169.72 74.96 213.76 104.38 0.281
MM post 154.05 54.29 128.50 45.53 166.60 56.21 0.054
MM delta 18.63 79.81 34.63 44.33 43.68 111.59 0.774
LVIDs pre 39.68 7.45 43.22 6.66 51.82 10.34 <0.001
LVIDs post 38.29 11.06 35.38 4.86 41.45 11.50 0.192
LVIDs delta 1.50 12.30 11.16 13.48 13.52 23.14 0.006
pre = prior aortic valve surgery; post = in follow-up; delta = calculated change (pre-post); EF = ejection fraction; EDV = end-diastolic volume (ml); ESV = end-systolic volume (ml); MM = myocardial mass (g/m2); LVIDs = left ventricle end-systolic diameter (mm); p = statistical significance.

Conclusion: Our results confirmed LV positive remodeling after AVR due to chronic AR, indicating that initial LVEF prior AVR could predict residual LV dilatation despite the reduction in EDV after AVR. In patients with LVEF>60% preoperatively, reversible positive remodeling after AVR may occur with complete normalization of ESV/EDV and LVIDs values during FU.

LITERATURE VollemaEMSinghGKPrihadiEARegeerMVEweSHNgACT Time course of left ventricular remodelling and mechanics after aortic valve surgery: aortic stenosis vs. aortic regurgitation. Eur Heart J Cardiovasc Imaging. 2019 October 1;20(10):1105–11. 10.1093/ehjci/jez04930932153 ZhangMKLiLNXueHTangXJSunHWuQY. Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement. J Cardiothorac Surg. 2022 January 16;17(1):8. 10.1186/s13019-022-01754-535034651