Prognostic value of left ventricular hypertrophy in postoperative outcomes in type A acute aortic dissection

Abstract

Background: Left ventricular hypertrophy (LVH) is common in hypertension patients. Hypertension is a recognized risk factor of acute aortic dissection. This study aimed to explore the prognostic value of LVH in predicting postoperative outcomes in acute type A aortic dissection (ATAAD) patients.

Methods: This was a single-central retrospectively designed study. One hundred and ninety-three ATAAD patients who underwent surgical repair at Renmin Hospital of Wuhan University from January 2018 to November 2021 were enrolled. Patients were divided based on their left ventricular mass index (LVMI). We compared their baseline characteristics, perioperative data, and in-hospital outcome. Then nomogram models were developed based on logistic regression to predict the postoperative outcomes.

Results: LVH presented in 28.5% (55 in 193) patients. LVH group had a higher proportion of female patients compared with the non-LVH group (32.7% vs. 17.4%, P=0.03). Decreased left ventricular ejection fraction and cardiac tamponade were more prevalent in patients with LVH. LVH group had a higher risk of postoperative composite major outcomes (CMO) and operative mortality. Based on multivariable logistic regression, LVH/LVMI, Penn classification, hyperlipidemia, emergency surgery and cardiopulmonary bypass duration were applied to develop nomogram models for predicting postoperative CMO. The area under curve was 0.825 (95% CI: 0.749-0.900) for Model LVH and 0.841 (95% CI: 0.776-0.905) for Model LVMI. Nomogram models for predicting postoperative cardiac were developed based on LVH/LVMI and cardiopulmonary bypass duration. The area under curves for the models involving LVH or LVMI were 0.782 (95% CI: 0.640-0.923) and 0.795 (95% CI: 0.643-0.947), respectively.

Conclusions: LVH and increased LVMI was associated with increased risk of postoperative CMO and cardiac events in ATAAD patients. The nomogram models based on LVH or LVMI might help predict postoperative CMO. Future research would be necessary to investigate prognostic value of LVH for long-term outcomes in ATAAD patients.

Keywords: Left ventricular hypertrophy (LVH); acute aortic dissection; outcome; risk factor; surgery.

Figure 1

Nomograms for postoperative CMO. (A) nomogram for model LVH. (B) nomogram for model LVMI. Nomograms can be interpreted by adding up the points assigned to each variable, as indicated at the top of the point scale. The total point projected on the bottom scale represents the probability of postoperative CMO. CMO, composite major outcomes; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index; CPB, cardiopulmonary bypass.

Figure 2

Nomograms for postoperative cardiac events. (A) Nomogram for model LVH. (B) Nomogram for model LVMI. Nomograms can be interpreted by adding up the points assigned to each variable, as indicated at the top of the point scale. The total point projected on the bottom scale represents the probability of postoperative cardiac events. LVH, left ventricular hypertrophy; LVMI, left ventricular mass index; CPB, cardiopulmonary bypass.

Figure 3

Validity test of the models for postoperative composite major outcomes. Both two models had an appropriate fit and a good predictive ability. (A) Calibration curve with area under curve (95% CI). (B) Decision curve analysis. AUC, area under the curve; CI, confidence interval; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index.

Figure 4

Validity test of the models for postoperative cardiac events. Both two models had an appropriate fit and a good predictive ability. (A) Calibration curve with area under curve (95% CI). (B) Decision curve analysis. AUC, area under the curve; CI, confidence interval; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index.