Echocardiographic predictors of left ventricular functional recovery following valve replacement surgery for severe aortic stenosis

Objective: We aimed to identify the most sensitive echocardiographic measurements that predict recovery of left ventricular function following valve replacement surgery in patients with severe aortic stenosis (AS) and LV dysfunction. Methods: We studied 66 patients ( mean age 70 +/- 2 years, 53 male) who underwent AVR for severe AS with concurrent LV dysfunction between 1998 and 2003 at the Royal Brompton Hospital. Clinical symptoms, co-morbidities and echocardiographic measurements of LV function were recorded before and at a median follow-up of 46 months after AVR. Pre-operative LV systolic dysfunction was defined as LV ejection fraction (EF) < 50% and the post-op LV recovery as an increase of EF > 10%. Results: Following AVR peak aortic pressure gradient decreased and aortic valve area index increased (64 +/- 3 to 19 +/- 1 mm Hg and 0.30 +/- 0.01 to 0.89 +/- 0.03 cm(2)/m(2), p < 0.001 for both). LV EF increased ( from 45 +/- 1 to 54 +/- 2%; p < 0.001) and the LV dimensions fell (LVEDD index: from 33 +/- 1 to 30 +/- 1 mm/m(2); and LVESD index: from 27 +/- 1 to 20 +/- 1 mm/m(2); p < 0.01 for both). LV diastolic dysfunction improved as evidenced by the fall in E/A ratio ( from 2.6 +/- 0.2 to 1.9 +/- 0.4) and prolongation of total filling time; ( from 29.2 +/- 0.6 to 31.4 +/- 0.5 s/min, p=0.01 for both). Among all echocardiographic variables, LV dimensions (LVEDD index, OR 0.70, CI 0.52-0.97, p < 0.05; LVESD index, OR 0.57, CI 0.40-0.85, p=0.005) were the two independent predictors of post-operative LV functional recovery on multivariate analysis. A cut off value of pre-operative LVESD index=< 27.5 mm/m(2) was 85% sensitive and 72% specific in predicting intermediate-term recovery of LV function after AVR (AUC, 0.72, p= 0.002). Conclusion: LV functional recovery was evident in majority of aortic stenotic patients with LV dysfunction after aortic valve replacement. A lower prevalence of LV functional recovery in patients with large pre-operative LV end systolic dimension index might signify the loss of contractile reserve and thus predict post-operative functional recovery. (c) 2007 Elsevier Ireland Ltd. All rights reserved.