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. 2016 Sep;24(3):201-207.
doi: 10.4250/jcu.2016.24.3.201. Epub 2016 Sep 26.

Impact of Valvuloarterial Impedance on Concentric Remodeling in Aortic Stenosis and Its Regression after Valve Replacement

Jeong Yoon Jang  1 , Jeong-Sook Seo  2 , Byung Joo Sun  3 , Dae-Hee Kim  4 , Jong-Min Song  4 , Duk-Hyun Kang  4 , Jae-Kwan Song  4
Affiliations

Impact of Valvuloarterial Impedance on Concentric Remodeling in Aortic Stenosis and Its Regression after Valve Replacement

Jeong Yoon Jang et al. J Cardiovasc Ultrasound. 2016 Sep.

Abstract

Background: Left ventricle (LV) in patients with aortic stenosis (AS) faces a double hemodynamic load incorporating both valvular stenosis and reduced systemic arterial compliance (SAC). This study aimed to evaluate the impact of global LV afterload on LV hypertrophy (LVH) before and after aortic valve replacement (AVR).

Methods: The study cohort included 453 patients (247 males; mean age, 64 ± 11 years) who underwent AVR. Pre- and post-AVR echocardiographic examinations were retrospectively analyzed including an index of valvuloarterial impedance (ZVA) and LV mass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LVH.

Results: Pre-AVR LVMI/LVEDVI was 2.7 ± 0.9 g/mL with an aortic valve area (AVA) of 0.6 ± 0.2 cm2. ZVA was 5.9 ± 1.9 mm Hg/mL/m2 and showed a stronger correlation (β = 0.601, p < 0.001) with pre-AVR LVMI/LVEDVI than indexed AVA (β = 0.061, p = 0.19), transvalvular peak velocity (β = 0.211, p < 0.001). During a median follow-up of 3.5 years, patients had a 18.8 ± 10.4% decrease in the LV geometry index with a decrease in SAC from 1.20 ± 0.48 to 1.00 ± 0.38 mL/m2/mm Hg (p < 0.001). Pre-AVR LV ejection fraction (r = 0.284, p < 0.001) and ZVA (r = 0.523, p < 0.001) were independent factors associated with LVH regression in 322 patients with follow-up duration >1 year after AVR.

Conclusion: ZVA is a major determinant of concentric remodeling in AS before AVR and LVH regression after AVR, which should be incorporated in routine evaluation of AS.

Keywords: Afterload; Aortic stenosis; Echocardiography; Left ventricular hypertrophy.

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Figures

Fig. 1
Fig. 1. Correlation between the various hemodynamic variables with LVMI/LVEDVI in patients with severe aortic stenosis. AV: aortic valve, PG: pressure gradient, AVA: aortic valve area, LVMI: left ventricle mass index, LVEDVI: left ventricle end-diastolic volume index, ZVA: valvuloarterial impedance, Vmax: transvalvular peak velocity.
Fig. 2
Fig. 2. Correlation between ZVA and SAC. SAC: systemic arterial compliance, ZVA: valvuloarterial impedance.
Fig. 3
Fig. 3. Study flow. AVR: aortic valve replacement, LVH: left ventricle hypertrophy.
Fig. 4
Fig. 4. Correlation between ZVA and changes in LVMI/LVEDVI after aortic valve replacement. ZVA: valvuloarterial impedance, LV: left ventricle, LVMI: LV mass index, LVEDVI: LV end-diastolic volume index.
See this image and copyright information in PMC

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