Table 4 Studies that have examined the significance of left ventricular structural and functional remodelling in aortic regurgitation (in chronological order)
From: Echocardiographic assessment of aortic regurgitation: a narrative review
Study | Year | Follow-up | Study population | Main findings |
|---|---|---|---|---|
Henry et al. [79] | 1980 | 5–43 months | 50 patients who underwent AVR for chronic severe AR | Pre-operative LVESD > 55mm and fractional shortening < 25% were strongly associated with high risk of post-operative heart failure or death or both |
Kumpuris et al. [80] | 1982 | 8 months | 43 patients with chronic and 14 patients with acute severe AR that underwent AVR | In patients with acute AR, LV dimensions normalised after AVR. In patients with chronic AR, some had persistent post-op LV dilatation. LVESD > 50mm was predictive of irreversible cardiac dilation |
Gaasch et al. [58] | 1983 | 1–6 years | 32 patients who underwent AVR for severe AR | 25 patients achieved normal LVEDDi post-operatively. These patients had less symptoms and significantly better 4-year survival, compared to the 7 patients who had persistent left ventricular enlargement. Pre-operative LVESDi > 25mm/m2 and LVEDDi > 38mm/m2 are predictive markers of persistent post-operative LV enlargement |
Bonow et al. [60] | 1988 | 3–7 years | 61 patients who underwent AVR for chronic severe AR | short-term and long-term improvement in left ventricular systolic function after operation is related significantly to the early reduction in left ventricular dilatation |
Tornos et al. [59] | 1995 | 10 ± 6 years | 101 asymptomatic patients with chronic severe AR | LVESD > 50mm and LVEF < 60% were independent predictors of cardiac symptoms or LV dysfunction |
Tarasoutchi et al. [81] | 2003 | 10 years | 75 patients with chronic severe AR | LVESD and age were the most predictive and specific, but not sensitive, indicators of symptom development. 10-year probability of developing symptoms was 58% for patients with LVEDD ≥ 70mm and 76% for patients with LVESD ≥ 50mm |
Sambola et al. [82] | 2008 | 8 ± 6 years | 147 patients who underwent AVR for chronic severe AR | LVESD and LVESDi were independent predictors of mortality after surgery. In patients with low BSA (≤ 1.68mm2), LVESDi ≥ 25mm/m2 should be used as a cut-off point for surgery rather than LVESD > 50mm |
Brown et al. [76] | 2009 | 10 years | 301 patients who had AVR for moderate or greater AVR | LVESDi and LVEDDi were predictors of late survival. Patients with LVESDi > 20mm/m2 and LVEDDi > 30mm/m2 had significantly worse 10-year mortality post-operatively |
Cho et al. [77] | 2010 | 6 months | 171 patients who underwent AVR for chronic severe AR | Preoperative LVESDi and LVEDDi were independent predictors of the LV post-surgical recovery. The sensitivity and specificity in predicting normalisation of LV function were 88% and 92% for indexed LVESDi < 35.32 mm/m2 and 71% and 86% for LVEDDi < 44.42mm/m2 |
Park et al. [72] | 2012 | 39.9 months | 284 patients who underwent AVR for chronic severe AR | Preoperative LVESD ≥ 45 mm and haemoglobin level < 13.4 g/dl are independent prognostic factors of survival after aortic valve surgery in patients with chronic severe AR and normal LV EFs |
Saisho et al. [83] | 2015 | 10 & 20 years | 177 patients who underwent AVR for chronic severe AR | LVESDi and cardiac index were independent predictors of LV recovery post-operatively. LVESDi > 26.7mm/m2 was the best cut-off value for predicting EF recovery after surgery |
Zhang et al. [66] | 2015 | 2 years | 105 patients who underwent AVR for chronic severe AR | Pre-operative EF > 52% is a good predictor of successful LV recovery early after AVR |
Wang et al. [63] | 2016 | 10 years | 192 asymptomatic patients with severe AR, LVEF ≥ 50% and LVEDD > 70 mm who underwent AVR | Pre-operative LVEF < 55% and LVEDD ≥ 81 mm were associated with poorer prognosis (5- and 10- year survival rates) in patients undergoing AVR |
Bruno et al. [84] | 2017 | 21 months | 119 patients who underwent AVR for chronic severe AR | Long-term postoperative survival was not affected by baseline EF, but age > 70 years and NYHA class III/IV symptoms were predictive of survival. In-hospital and long-term survival was similar in patients with severe LV dysfunction and with preserved or moderately reduced LV function |
Maeda et al. [75] | 2019 | 10 ± 5 years | 268 patients who underwent AVR for chronic severe AR | Long-term (10-year) survival after AVR was significantly worse in patients with LVESDi > 25mm/ m2 and/or LVEDD > 65mm |
De Meester et al. [70] | 2019 | 10 years | 356 patients who underwent AVR for chronic severe AR | LVEF < 55% and LVESDi > 20 to 22 mm/m2 were markers of increased 10-year mortality. LV end-diastolic dimensions did not influence outcomes |
Yang et al. [71] | 2019 | 4.9 years | 748 patients with significant AR, of whom 361 patients had AVR | LVESDi was the only LV parameter independently associated with all-cause mortality. Compared with patients having LVESDi < 20 mm/m2, those with LVESDi 20 to 25 mm/m2 (HR: 1.53; 95% CI: 1.01–2.31) and ≥ 25 mm/m2 (HR: 2.23; 95% CI: 1.32–3.77) had increased risk of death |
Dong et al. [65] | 2020 | 10 years | 212 patients with LVEF < 50% and LVEDD ≥ 70mm who underwent AVR for chronic severe AR | In-hospital mortality was associated with preoperative age and LVEF. Patients with markedly reduced LV function (LVEF < 35%) had lower survival rates compared with other patients with moderate LV dysfunction (LVEF 36% to 50%) |
Kim et al. [64] | 2020 | 8.7 years | 280 patients who underwent AVR for chronic severe AR | Patients with reduced LVEF (< 50%) had lower overall postoperative survival and cardiac mortality‐free survival rates than the preserved LVEF group at 5 and 10 years. Preoperative E/e′ was associated with postoperative improvement or normalization of LVEF and all‐cause mortality in the patients with reduced LVEF |
Koga-Ikuta et al. [85] | 2021 | 1 year | 246 patients who underwent AVR for chronic severe AR | Pre-operative LVEF and LVESDi were significant predictive factors of reverse remodelling 1 year after surgery, which was associated with late outcomes |
Yang et al. [67] | 2021 | 5.4 years | 492 asymptomatic patients with chronic moderate to severe and severe AR | LVEF, LVESDi and LVESVi were independently associated with mortality. A LVESVi threshold of 45 mL/m2 or greater was significantly associated with an increased mortality risk |
Anand et al. [73] | 2021 | 5.4 years | 1100 patients with chronic moderate to severe and severe AR | Both LVESVi and LVESDi were associated with worse outcomes, but the association of LVESVi was stronger. LVESVi ≥ 45 mL/m2 was associated with worse outcomes |
Iliuta et al. [86] | 2022 | 2 years | 332 patients who underwent AVR for chronic severe AR | The restrictive LV diastolic filling pattern was an independent predictor for early and medium-term postoperative mortality. Other independent predictors for increased early postoperative mortality rate include advanced age (> 75 years), LVESD > 58 mm, and comorbidities (diabetes mellitus, COPD) |
Yang et al. [68] | 2023 | 4.1 years | 1259 patients with chronic moderate to severe and severe AR | All-cause and cardiovascular mortality were increased when LVEF ≤ 53%, LVESDi ≥ 22 mm/m2 and LVESVi ≥ of 46 mL/m2. Early surgery was beneficial in 3 strata of LVESDi (< 20, 20 to < 25, and ≥ 25 mm/m2) and 2 strata of LVESVi (< 46 and ≥ 46 mL/m2) |