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Evaluation of left ventricular reverse remodeling in patients with severe aortic regurgitation undergoing aortic valve replacement: Comparison between diameters and volumes
Author(s) -
Ong Géraldine,
Redfors Bjorn,
Crowley Aaron,
AbdelQadir Husam,
Harrington Alana,
Liu Yangbo,
LafrenièreRoula Myriam,
LeongPoi Howard,
Peterson Mark D.,
Connelly Kim A.
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13750
Subject(s) - medicine , ventricle , cardiology , ejection fraction , ventricular remodeling , aortic valve replacement , regurgitation (circulation) , diastole , heart failure , blood pressure , stenosis
Background In patients with severe aortic regurgitation ( AR ), the left ventricular ejection fraction ( LVEF ) and left ventricle ( LV ) size are crucial for determining clinical prognosis and timing of valve intervention. In clinical practice, LV internal diameters obtained at end‐diastole are used to assess the degree of LV dilatation. Whether quantification of LV volumes would provide more robust information as compared to LV linear dimensions is unknown. Methods We retrospectively analyzed preoperative and postoperative transthoracic echocardiograms of patients who underwent aortic valve replacement ( AVR ) for severe AR . Indexed linear LV end‐diastolic and end‐systolic diameters along with indexed LV end‐diastolic and end‐systolic volumes were obtained as per current guidelines. Post‐ AVR LV reverse remodeling, defined as ≥10% reduction in measures of LV volumes (Teichholz and Simpson's methods), was determined. Positive and negative agreement was calculated between the volume‐ and diameter‐based LV reverse remodeling. Results Sixty‐two consecutive patients were included. Nine patients (17%) without LV reverse remodeling based on Teichholz were reclassified as having LV reverse remodeling based on Simpson (positive agreement 0.846 [95% CI 0.772, 0.921], negative agreement 0.200 [95% CI −0.350, 0.435]). Left ventricle ( LV ) reverse remodeling assessed by the Teichholz method was underestimated by a mean of 31 mL/m 2 (β = −0.65 [95% CI −1.06 to −0.24], P = .003) compared to Simpson method. Conclusion Compared to the volume‐based method, diameter‐based LV measurement incorrectly identified LV reverse remodeling post‐ AVR in 17% of patients with severe AR . Left ventricle ( LV ) volume may be a better measure to assess LV remodeling post‐ AVR than LV diameter‐based measurements.