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CLINICAL STUDY

Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitation

Hildo J. Lamb, PhD^*,*,1, Hugo P. Beyerbacht, MD, Albert de Roos, MD^*, Arnoud van der Laarse, PhD, Hubert W. Vliegen, MD, Ferre Leujes, MD, Jeroen J. Bax, MD and Ernst E. van der Wall, MD

^* Radiology, Leiden, The Netherlands
Cardiology, Leiden University Medical Center, Leiden, The Netherlands

Manuscript received March 6, 2002; revised manuscript received August 16, 2002, accepted September 6, 2002.

^* Reprint requests: Dr. Ernst E. van der Wall, Department of Cardiology, C5-P28, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
E.E.van_der_Wall{at}lumc.nl

OBJECTIVES: The aim of this study was to evaluate the effect of aortic valve replacement (AVR) on left ventricular (LV) function and LV remodeling, comparing patients with aortic valve stenosis to patients with aortic regurgitation.

BACKGROUND: Aortic valve disease is associated with eccentric or concentric LV hypertrophy and changes in LV function. The relationship between LV geometry and LV function and the effect of LV remodeling after AVR on diastolic filling, in patients with aortic valve stenosis compared with aortic regurgitation, are largely unknown.

METHODS: Nineteen patients with aortic valve disease (12 aortic valve stenosis, 7 aortic regurgitation) were studied using magnetic resonance imaging to assess LV geometry and LV function before and 9 ± 3 months after AVR. Ten age-matched healthy males served as control subjects.

RESULTS: Before AVR, the ratio between left ventricular mass index (LVMI) and left ventricular end-diastolic volume index (LVEDVI) was only increased in patients with aortic valve stenosis (1.37 ± 0.16 g/ml) compared with control subjects (0.93 ± 0.08 g/ml, p < 0.05). After AVR, LVMI/LVEDVI decreased significantly in aortic valve stenosis (to 1.15 ± 0.14 g/ml, p < 0.0001), but increased significantly in aortic regurgitation (1.02 ± 0.20 g/ml to 1.44 ± 0.27 g/ml, p < 0.0001). Before AVR, diastolic filling was impaired in both aortic valve stenosis and aortic regurgitation. Early after AVR, diastolic filling improved in patients with aortic valve stenosis, whereas patients with aortic regurgitation showed a deterioration in diastolic filling.

CONCLUSIONS: Early after AVR, patients with aortic valve stenosis show a decrease in both LVMI and LVMI/LVEDVI and an improvement in diastolic filling, whereas in patients with aortic regurgitation, LVMI decreases less rapidly than LVEDVI, causing concentric remodeling of the LV, most likely explaining the observed deterioration of diastolic filling in these patients.

Abbreviations and Acronyms   AVR   aortic valve replacement   CO   cardiac output   E   early diastolic filling   LV   left ventricular   LVEDVI   left ventricular end-diastolic volume index   LVEF   left ventricular ejection fraction   LVH   left ventricular hypertrophy   LVMI   left ventricular mass index   MR   magnetic resonance

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