Preoperative contractility deficit (ΔLVEF - ΔESS) predicted postoperative survival after aortic valve replacement for severe aortic regurgitation (p=0.009).
Cohort (n=66)
Does preoperative noninvasive measurement of myocardial contractility (ΔLVEF - ΔESS) predict postoperative survival in patients undergoing aortic valve replacement for severe aortic regurgitation?
Preoperative noninvasive measurement of myocardial contractility (ΔLVEF - ΔESS) is a strong, independent predictor of long-term survival after aortic valve replacement for severe aortic regurgitation.
p-value: p=0.009
BACKGROUND: Noninvasive measurement of myocardial contractility (end-systolic wall stress-adjusted change in left ventricular ejection fraction from rest to exercise ΔLVEF - ΔESS) predicts heart failure, subnormal LVEFrest, and sudden death in asymptomatic patients with chronic severe aortic regurgitation (AR). Here we assess the relation of preoperative ΔLVEF - ΔESS to survival after aortic valve replacement (AVR). METHODS: Patients who underwent AVR for chronic, isolated, pure severe AR (n = 66) were followed for 13.0 ± 6.4 event-free years. Preoperative ΔLVEF - ΔESS (from combined echocardiographic and radionuclide cineangiographic data) enabled cohort stratification into 3 terciles (-1 to -11% normal or mild contractility deficit, -12 to -16% moderate, and ≤-17% severe, identical with segregation in our earlier study) to relate preoperative contractility to postoperative survival and to age- and gender-matched US census data. RESULTS: Since AVR, 22 patients died (average annual risk AAR for all-cause mortality for the entire co hort = 3.15%). Preoperative ΔLVEF - ΔESS predicted postoperative survival (p = 0.009, log rank test). By contractility terciles, all-cause AARs were 1.44, 2.58, and 6.40%. Survival was lower than among US census comparators (p < 0.02), but the "mild" tercile was indistinguishable from census data (p = ns). By multivariable Cox regression, survival prediction by pre-AVR ΔLVEF - ΔESS was independent of, and superior to, prediction by age at surgery, gender, preoperative functional class, LVEFrest, LVEFexercise, change in LVEFrest to exercise, and LV diastolic or systolic dimensions (p ≤ 0.01, pre-AVR ΔLVEF - ΔESS vs. other covariates). CONCLUSION: In severe AR, preoperative contractility predicts post-AVR survival and may be prognostically superior to clinical, geometric and performance descriptors, potentially impacting on patient selection for surgery.
Borer et al. (2018) conducted a cohort in Chronic, isolated, pure severe aortic regurgitation (n=66). Preoperative contractility measurement (ΔLVEF - ΔESS) vs. Different contractility terciles and US census data was evaluated on Postoperative survival (p=0.009). Preoperative contractility deficit (ΔLVEF - ΔESS) predicted postoperative survival after aortic valve replacement for severe aortic regurgitation (p=0.009).