Impact of moderate coronary atherosclerosis on long-term left ventricular remodeling after aortic valve replacemen

Abstract

Background: The role of coronary atherosclerosis (CA+) in ventricular remodeling after aortic valve replacement (AVR) for isolated aortic stenosis (AS) is not well defined. We sought to evaluate the impact of not revascularized moderate coronary atherosclerosis in long-term left ventricular (LV) remodeling after AVR.

Methods: We assessed by coronariography the coronary artery disease in 66 patients referred for AVR and evaluated morphological and functional LV data by echocardiography both preoperatively and postoperatively (3 ± 1.2 years).

Results: In patients without coronary atherosclerosis, hypertrophy regression was more intense and the absolute reverse remodeling was higher in LV mass index (-55.8 ± 36 g/m² vs -28.4 ± 34 g/m², p = 0.004), reduction of LV dimensions (LV end-diastolic diameter [LVEDD]: -4.1 ± 7.4 mm vs -2.2 ± 8.3 mm, p = 0.04), and regression of wall thickness (interventricular septum [IVS]: -3.3 ± 2.6 mm vs -1.6 ± 2.2 mm, p = 0.01; and posterior wall thickness [PWT]: -2.1 ± 2.1 mm vs 0.6 ± 2.1 mm, p = 0.012).

Conclusions: After AVR for AS, not revascularized moderate coronary atherosclerosis determines a long-term lesser degree of LV hypertrophy regression and a worse absolute reverse remodeling of LV mass index, LVEDD, IVS and PWT.