Abstract
BACKGROUND: Long-term results after aortic value replacement for aortic stenosis can be correlated to a cardiac-related pre-operative risk profile. This predictability indicates that there is a common basis in subtle or overt structural abnormalities of left ventricular myocardium.
METHODS AND RESULTS: Forty-nine patients aged 24-82 (mean 61) years, with aortic stenosis had a full wall thickness transmural biopsy of the left ventricular antero-lateral free wall during aortic valve replacement. Echocardiography and radionuclide ventriculography were performed prior to, and 18 months (n = 41) after, the operation. Postoperative follow-up to a maximum of 7.7 years was 100% complete. Pre-operatively, all patients had an increase in both the left ventricular mass index (202 +/- 67 g.m-2) and the muscle cell diameter (41 +/- 8 microns); other morphological data included a muscle cell nucleus volume of 752 +/- 192 microns3, a muscle cell mass index of 163 +/- 54.m-2, and a fibrous tissue mass index of 39 +/- 16 g.m-2. Patients with a pre-operative episode of clinical left ventricular failure (n = 19) had significantly greater morphological variables than those without. Pre-operative ejection fraction and other measures of systolic function correlated inversely with the morphological data, except for the fibrous tissue mass index; diastolic function indices correlated inversely with all the morphological variables. At the 18-month re-study, the same general picture was noted, but with an underlying strengthening, especially of the muscle cell mass index. Overall, the mass index dropped to 152 +/- 51 g.m-2 (P < 0.0001), but in 17% of the patients it became normal; the mass index at 18 months was directly correlated to morphological variables. A high muscle cell nucleus volume was identified as an independent predictor of early and late mortality.
CONCLUSIONS: Abnormalities of the hypertrophied left ventricular muscle cell and the degree of muscle hypertrophy are, to some degree, underlying determinants of pre-operative symptomatology, pre- and postoperative ventricular function, and early and late mortality after valve replacement for aortic stenosis. Incomplete hypertrophy impaired results, was related to pre-operative myocardial structural abnormalities.
Original language | English |
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Journal | European Heart Journal |
Volume | 19 |
Issue number | 7 |
Pages (from-to) | 1099-108 |
Number of pages | 10 |
ISSN | 0195-668X |
DOIs | |
Publication status | Published - Jul 1998 |
Externally published | Yes |
Keywords
- Adult
- Aged
- Aged, 80 and over
- Aortic Valve Stenosis/mortality
- Cardiomyopathy, Dilated/mortality
- Diastole/physiology
- Female
- Heart Valve Prosthesis Implantation
- Hemodynamics/physiology
- Humans
- Hypertrophy, Left Ventricular/mortality
- Male
- Middle Aged
- Myocardium/pathology
- Postoperative Complications/mortality
- Prognosis
- Risk Factors
- Survival Rate
- Systole/physiology
- Treatment Outcome
- Ventricular Dysfunction, Left/mortality
- Ventricular Function, Left/physiology