Key result
Aortic valve replacement significantly increased circulatory efficiency from 9% to 13% in patients with severe aortic valve stenosis, though values remained below normal in 24% of patients.
Why the study?
The effect of severe aortic valve stenosis and aortic valve replacement on left ventricular and circulatory mechanical power and efficiency is not yet fully understood.
Does surgical aortic valve replacement improve circulatory efficiency in patients with severe aortic valve stenosis?
Cohort (n=51)
No
Does surgical aortic valve replacement improve circulatory efficiency in patients with severe aortic valve stenosis?
Surgical aortic valve replacement significantly improves circulatory efficiency and reduces myocardial fibrosis in most patients with severe aortic stenosis, though a subset (24%) fails to normalize.
Answers are grounded in this paper and cite their sources.
May enhance efficiency post-AVR in severe AS; leaves open prognostic impact of incomplete normalization.
BACKGROUND: Circulatory efficiency reflects the ratio between total left ventricular work and the work required for maintaining cardiovascular circulation. The effect of severe aortic valve stenosis (AS) and aortic valve replacement (AVR) on left ventricular/circulatory mechanical power and efficiency is not yet fully understood. We aimed to quantify left ventricular (LV) efficiency in patients with severe AS before and after surgical AVR. METHODS: Circulatory efficiency was computed from cardiovascular magnetic resonance (CMR) imaging derived volumetric data, echocardiographic and clinical data in patients with severe AS (n = 41) before and 4 months after AVR and in age and sex-matched healthy subjects (n = 10). RESULTS: In patients with AS circulatory efficiency was significantly decreased compared to healthy subjects (9 ± 3% vs 12 ± 2%; p = 0.004). There were significant negative correlations between circulatory efficiency and LV myocardial mass (r = - 0.591, p < 0.001), myocardial fibrosis volume (r = - 0.427, p = 0.015), end systolic volume (r = - 0.609, p < 0.001) and NT-proBNP (r = - 0.444, p = 0.009) and significant positive correlation between circulatory efficiency and LV ejection fraction (r = 0.704, p < 0.001). After AVR, circulatory efficiency increased significantly in the total cohort (9 ± 3 vs 13 ± 5%; p < 0.001). However, in 10/41 (24%) patients, circulatory efficiency remained below 10% after AVR and, thus, did not restore to normal values. These patients also showed less reduction in myocardial fibrosis volume compared to patients with restored circulatory efficiency after AVR. CONCLUSION: In our cohort, circulatory efficiency is reduced in patients with severe AS. In 76% of cases, AVR leads to normalization of circulatory efficiency. However, in 24% of patients, circulatory efficiency remained below normal values even after successful AVR. In these patients also less regression of myocardial fibrosis volume was seen. Trial Registration clinicaltrials.gov NCT03172338, June 1, 2017, retrospectively registered.
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Nordmeyer et al. (2021) conducted a cohort in Severe aortic valve stenosis (n=51). Aortic valve replacement vs. Pre-operative baseline was evaluated on Circulatory efficiency (p=<0.001). Aortic valve replacement significantly increased circulatory efficiency from 9% to 13% in patients with severe aortic valve stenosis, though values remained below normal in 24% of patients.
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