J Cardiovasc Ultrasound.  2016 Sep;24(3):201-207. 10.4250/jcu.2016.24.3.201.

Impact of Valvuloarterial Impedance on Concentric Remodeling in Aortic Stenosis and Its Regression after Valve Replacement

• Jang JY
• Seo JS
• Sun BJ
• Kim DH
• Song JM
• Kang DH
• Song JK

• KMID: 2353097
• DOI: http://doi.org/10.4250/jcu.2016.24.3.201

Abstract

BACKGROUND
Left ventricle (LV) in patients with aortic stenosis (AS) faces a double hemodynamic load incorporating both valvular stenosis and reduced systemic arterial compliance (SAC). This study aimed to evaluate the impact of global LV afterload on LV hypertrophy (LVH) before and after aortic valve replacement (AVR).
METHODS
The study cohort included 453 patients (247 males; mean age, 64 ± 11 years) who underwent AVR. Pre- and post-AVR echocardiographic examinations were retrospectively analyzed including an index of valvuloarterial impedance (Z(VA)) and LV mass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LVH.
RESULTS
Pre-AVR LVMI/LVEDVI was 2.7 ± 0.9 g/mL with an aortic valve area (AVA) of 0.6 ± 0.2 cm². Z(VA) was 5.9 ± 1.9 mm Hg/mL/m² and showed a stronger correlation (β = 0.601, p < 0.001) with pre-AVR LVMI/LVEDVI than indexed AVA (β = 0.061, p = 0.19), transvalvular peak velocity (β = 0.211, p < 0.001). During a median follow-up of 3.5 years, patients had a 18.8 ± 10.4% decrease in the LV geometry index with a decrease in SAC from 1.20 ± 0.48 to 1.00 ± 0.38 mL/m²/mm Hg (p < 0.001). Pre-AVR LV ejection fraction (r = 0.284, p < 0.001) and Z(VA) (r = 0.523, p < 0.001) were independent factors associated with LVH regression in 322 patients with follow-up duration >1 year after AVR.
CONCLUSION
Z(VA) is a major determinant of concentric remodeling in AS before AVR and LVH regression after AVR, which should be incorporated in routine evaluation of AS.

Keyword

Aortic stenosis; Left ventricular hypertrophy; Afterload; Echocardiography

MeSH Terms

Aortic Valve
Aortic Valve Stenosis*
Cohort Studies
Compliance
Constriction, Pathologic
Echocardiography
Electric Impedance*
Follow-Up Studies
Heart Ventricles
Hemodynamics
Humans
Hypertrophy
Hypertrophy, Left Ventricular
Male
Retrospective Studies

Figure

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  Fig. 1 Correlation between the various hemodynamic variables with LVMI/LVEDVI in patients with severe aortic stenosis. AV: aortic valve, PG: pressure gradient, AVA: aortic valve area, LVMI: left ventricle mass index, LVEDVI: left ventricle end-diastolic volume index, ZVA: valvuloarterial impedance, Vmax: transvalvular peak velocity.

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  Fig. 2 Correlation between ZVA and SAC. SAC: systemic arterial compliance, ZVA: valvuloarterial impedance.

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  Fig. 3 Study flow. AVR: aortic valve replacement, LVH: left ventricle hypertrophy.

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  Fig. 4 Correlation between ZVA and changes in LVMI/LVEDVI after aortic valve replacement. ZVA: valvuloarterial impedance, LV: left ventricle, LVMI: LV mass index, LVEDVI: LV end-diastolic volume index.

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