Original Research
The evaluation of the predictors of left ventricular systolic function improvement in patients with severe aortic stenosis after aortic valve replacement
N.V. Ponych 1, O.J. Zharinov 2, O.A. Yepanchintseva 1, B.M. Todurov 1, 2
1 Heart Institute of Healthcare Ministry of Ukraine, Kyiv, Ukraine
2 Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
The aim – to evaluate clinical and echocardiographic predictors of the systolic function improvement in patients with aortic stenosis (AS) and low left ventricular ejection fraction (LVEF) after aortic valve replacement (AVR).
Material and methods. One-center study analyzed data received at clinical and instrumental examination of 72 consecutively examined patients with severe aortic stenosis and systolic dysfunction (LVEF less than 45 %) selected for AVR with or without coronary artery bypass grafting (CABG). The average age of patients was 62 (lower-upper quartiles 34–79) years. All patients underwent clinical and instrumental investigations, including transthoracic echocardiography and coronary angiography. Patients were retrospectively divided into two groups: 48 (66.76 %) patients with left ventricular ejection fraction increased more than 30 % in the early post-surgery period, and 24 (33.3 %) – less than 30 %. In 21 (29.2 %) patients AVR was combined with CABG.
Results. Group of patients with greater growth of LVEF was characterized by lower body mass index (p = 0.016), greater initial signs of heart failure (p = 0.019), less frequent arterial hypertension. In addition, patients with LVEF growth over 30 % had more pronounced decrease of initial EF, greater end-systolic volume (ESV) index and changes of some indices of diastolic LV function. The smaller increase in LVEF was associated with greater rate of atrial fibrillation (p = 0.028) and aortic regurgitation I degree (p = 0.012).
Conclusions. The median LVEF in patients with AS and systolic dysfunction after AVR increased from 29 to 43 %. Under proper selection of patients with AS and reduced LVEF for surgery more than 30 % improvement of LVEF may be expected at early postoperative period. Critical AS with reduced LVEF, including low-flow, low gradient AS should not be regarded as an independent restriction to AVR.
Key words: prosthesis, aortic valve, systolic dysfunction, left ventricle.
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