Additional Prognostic Value of Tissue Doppler Evaluation in Patients with Aortic Stenosis and Left-Ventricular Systolic Dysfunction Undergoing Aortic Valve Replacement

Luminita Iliuta; Andreea Gabriella Andronesi; Camelia Cristina Diaconu; Eugenia Panaitescu; Georgiana Camburu

doi:10.3390/medicina58101410

Additional Prognostic Value of Tissue Doppler Evaluation in Patients with Aortic Stenosis and Left-Ventricular Systolic Dysfunction Undergoing Aortic Valve Replacement

Medicina (Kaunas). 2022 Oct 7;58(10):1410. doi: 10.3390/medicina58101410.

Authors

Luminita Iliuta^{1

2}, Andreea Gabriella Andronesi^{3

4}, Camelia Cristina Diaconu^{5

6

7}, Eugenia Panaitescu¹, Georgiana Camburu¹

Affiliations

¹ Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
² Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania.
³ Nephrology Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
⁴ Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania.
⁵ Internal Medicine Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
⁶ Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania.
⁷ Academy of Romanian Scientists, 3 Ilfov Street, 050044 Bucharest, Romania.

Abstract

Background and Objectives: Patients with surgical aortic stenosis (AS) show impaired diastolic filling, which is a risk factor for early and late mortality after aortic valve replacement (AVR). There is a paucity of information concerning the impact of restrictive diastolic filling and the evolution of diastolic dysfunction in the early and medium terms post-AVR. We aimed to determine the prognostic value of the presence of a restrictive left-ventricular (LV) diastolic filling pattern (LVDFP) and dilated left atrium (LA) in patients with AS and LV systolic dysfunction (LVEF < 40%) who underwent AVR, and to define the independent predictors for immediate and long-term prognosis and their value for preoperative risk estimation. Materials and Methods: The study was prospective and included 197 patients with surgical AS and LVEF <40% who underwent AVR. Preoperative echocardiographic examinations were repeated at day 10, at 1, 3 and 6 months, and at 1 and 2 years after surgery, with evaluation of LVEF, diastolic function and LA dimension index (mm/m2). Depending on LV systolic performance, patients were classified as Group A (LVEF: 30−40%) or Group B (LVEF < 30%). Results: The main echographic independent parameters for early and late postoperative death were: restrictive LVDFP, significant pulmonary hypertension, LV end-systolic diameter (LVESD) >55 mm and the presence of second-degree mitral regurgitation. Restrictive LVDFP and LA dimension >30 mm/m2 were independent predictors for fatal outcome (p = 0.0017). Conclusions: Assessment of diastolic function and LA dimension are reliable parameters in predicting fatal outcome and hospitalization for heart failure, having an independent and incremental prognostic value in patients with surgical AS. Complete evaluation of LVDFP with all the echographic measurements (including TDI) should routinely be part of the preoperative assessment of patients with LV systolic dysfunction undergoing AVR.

Keywords: aortic stenosis; aortic valve replacement; restrictive diastolic filling pattern; systolic dysfunction.

MeSH terms

Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / surgery
Echocardiography, Doppler / adverse effects
Echocardiography, Doppler / methods
Heart Valve Prosthesis Implantation*
Humans
Prognosis
Prospective Studies
Retrospective Studies
Stroke Volume
Ventricular Dysfunction, Left*
Ventricular Function, Left

Grants and funding

This research received no external funding.