Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery

Brestovac, Marija; Glavaš, Blanka; Jakšić Jurinjak, Sandra; Rešković Lukšić, Vlatka; Lovrić Benčić, Martina; Pašalić, Marijan; Šeparović Hanževački, Jadranka

doi:10.15836/ccar2024.456

Cardiologia Croatica, Vol. 19 No. 11-12, 2024.

Meeting abstract

https://doi.org/10.15836/ccar2024.456

Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery

Marija Brestovac orcid.org/0000-0003-1542-2890 ; University Hospital Centre Zagreb, Zagreb, Croatia
Blanka Glavaš orcid.org/0000-0003-1134-4856 ; University Hospital Centre Zagreb, Zagreb, Croatia
Sandra Jakšić Jurinjak orcid.org/0000-0002-7349-6137 ; University Hospital Centre Zagreb, Zagreb, Croatia
Vlatka Rešković Lukšić orcid.org/0000-0002-4721-3236 ; University Hospital Centre Zagreb, Zagreb, Croatia
Martina Lovrić Benčić orcid.org/0000-0001-8446-6120 ; University Hospital Centre Zagreb, Zagreb, Croatia
Marijan Pašalić orcid.org/0000-0002-3197-2190 ; University Hospital Centre Zagreb, Zagreb, Croatia
Jadranka Šeparović Hanževački orcid.org/0000-0002-3437-6407 ; University Hospital Centre Zagreb, Zagreb, Croatia

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APA 6th Edition

Brestovac, M., Glavaš, B., Jakšić Jurinjak, S., Rešković Lukšić, V., Lovrić Benčić, M., Pašalić, M. & Šeparović Hanževački, J. (2024). Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery. Cardiologia Croatica, 19 (11-12), 456-457. https://doi.org/10.15836/ccar2024.456

MLA 8th Edition

Brestovac, Marija, et al. "Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery." Cardiologia Croatica, vol. 19, no. 11-12, 2024, pp. 456-457. https://doi.org/10.15836/ccar2024.456. Accessed 18 May 2026.

Chicago 17th Edition

Brestovac, Marija, Blanka Glavaš, Sandra Jakšić Jurinjak, Vlatka Rešković Lukšić, Martina Lovrić Benčić, Marijan Pašalić and Jadranka Šeparović Hanževački. "Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery." Cardiologia Croatica 19, no. 11-12 (2024): 456-457. https://doi.org/10.15836/ccar2024.456

Harvard

Brestovac, M., et al. (2024). 'Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery', Cardiologia Croatica, 19(11-12), pp. 456-457. https://doi.org/10.15836/ccar2024.456

Vancouver

Brestovac M, Glavaš B, Jakšić Jurinjak S, Rešković Lukšić V, Lovrić Benčić M, Pašalić M, et al. Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery. Cardiologia Croatica [Internet]. 2024 [cited 2026 May 18];19(11-12):456-457. https://doi.org/10.15836/ccar2024.456

IEEE

M. Brestovac, et al., "Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery", Cardiologia Croatica, vol.19, no. 11-12, pp. 456-457, 2024. [Online]. https://doi.org/10.15836/ccar2024.456

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Abstract

Keywords

aortic regurgitation; left ventricle remodeling; timing for aortic valve replacement

Hrčak ID:

328009

URI

https://hrcak.srce.hr/328009

Publication date:

13.12.2024.

Visits: 340 *

Article information

Date received: 13 October 2024

Date: 31 October 2024

Publication date: November 2024

Volume: 19

Issue: 11-12

Pages: 456-457

Publisher ID: CC 2024 19_11-12_456-7

DOI: 10.15836/ccar2024.456

Article Information (continued)

Categories:

Subject: Extended Abstract

Categories:

Subject: Valvular heart disease

KEYWORDS: :

KEYWORDS:

Keyword: aortic regurgitation

Keyword: left ventricle remodeling

Keyword: timing for aortic valve replacement

Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery

[https://orcid.org/0000-0003-1542-2890] Marija Brestovac[¹][*]

[https://orcid.org/0000-0003-1134-4856] Blanka Glavaš[¹]

[https://orcid.org/0000-0002-7349-6137] Sandra Jakšić Jurinjak[¹]

[https://orcid.org/0000-0002-4721-3236] Vlatka Rešković Lukšić[¹][²]

[https://orcid.org/0000-0001-8446-6120] Martina Lovrić Benčić[¹][²]

[https://orcid.org/0000-0002-3197-2190] Marijan Pašalić[¹]

[https://orcid.org/0000-0002-3437-6407] Jadranka Šeparović Hanževački[¹][²]

[1] University Hospital Centre Zagreb, Zagreb, Croatia

[2] University of Zagreb, School of Medicine, Zagreb, Croatia

Author notes:

Correspondence to: [*] ADDRESS FOR CORRESPONDENCE: Marija Brestovac, Klinički bolnički centar Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia. / Phone: +385-99-7742-627 / E-mail: marija.brestovac@gmail.com

Introduction: Significant aortic regurgitation (sAR) results in left ventricle (LV) remodeling and LV dysfunction due to chronic pressure and a volume overload. Timing of surgical intervention is defined by left ventricle ejection fraction (LVEF) <50% and end-systolic diameter (LVIDs) > 50 mm. (1,2) The aim of this study was to investigate if there is difference in LV positive remodeling after AV surgery, according to LVEF above cut of value (EF>50%) at the timing of surgery.

Patients and Methods: We retrospectively analyzed echocardiographic (ECHO) database for 52 patients (pt) who underwent aortic valve surgery (AVR) from January 2017 to April 2021 due to sAR, in UHC Zagreb. Preoperative ECHO data as well as during follow-up (FU) were analyzed. The study population was divided in three groups according to initial LVEF values: group (I) included 17 pt with EF>60% (mean age 54+/-9.4), group (II) 16 pt with EF 50-60% (mean age 52+/-15.7) and group (III) 19 pt with EF<50% (mean age 60+/-6.3). ECHO parameters of LV remodeling; end-diastolic volume (EDV, ml), end-systolic volume (ESV, ml), myocardial mass (MM, g/m²) and left ventricular internal dimension at end-systole (LVIDs, mm) were compared prior surgery and in the mean FU time of 38 months.

Results: The change in absolute values of ECHO parameters and their calculated mean change are shown in (Figure 1) and (Table 1). Preoperatively, group III revealed the highest EDV/ESV/LVIDs values 259.18/148.6/51 compared to group I and II (186.11/76.83/39.6 vs. 182.21/86.8/40.2). During FU after AVR, no difference in reduction in EDV and MM (EDV p=0.115, MM p=0.774) was noticed between the 3 groups, while absolute values almost reached normal ranges only in group I and II (EDV 138.7 in I and 138.8 in II). Importantly, normalization of ESV and LVIDs during FU was shown only in group I and II, while rate of change was highest in group III (ΔESV 40.3, ΔLVIDs 13.5), LVIDs decreased more in more dilated LV (p=0.006) and even though ESV reduced in all three groups, in group III it remained enlarged (p=0.006), as expected.

FIGURE 1 Change in absolute values of end-diastolic volume, end-systolic volume, myocardial mass, and left ventricular internal dimension at end-systole after aortic valve surgery in patients surgically treated due to significant aortic regurgitation.

TABLE 1 Absolute values and calculated change in end-diastolic volume, end-systolic volume, myocardial mass, and left ventricular internal dimension at end-systole in 3 patient groups divided according to ejection fraction prior to aortic valve surgery due to aortic regurgitation.

	Group						p
	EF>60%		50%<EF<60%		EF<50%
	Mean	Standard Deviation	Mean	Standard Deviation	Mean	Standard Deviation
EDV pre	186.11	62.46	182.21	52.65	259.18	87.95	0.002
EDV post	138.74	59.56	138.88	50.30	174.55	61.26	0.101
EDV delta	44.94	55.13	40.25	63.69	80.74	81.31	0.115
ESV pre	76.83	24.71	86.84	28.39	148.59	50.02	0.000
ESV post	69.74	38.89	66.81	22.05	105.75	53.67	0.018
ESV delta	8.47	35.10	20.63	34.26	40.37	42.92	0.006
MM pre	170.76	58.20	169.72	74.96	213.76	104.38	0.281
MM post	154.05	54.29	128.50	45.53	166.60	56.21	0.054
MM delta	18.63	79.81	34.63	44.33	43.68	111.59	0.774
LVIDs pre	39.68	7.45	43.22	6.66	51.82	10.34	<0.001
LVIDs post	38.29	11.06	35.38	4.86	41.45	11.50	0.192
LVIDs delta	1.50	12.30	11.16	13.48	13.52	23.14	0.006
pre = prior aortic valve surgery; post = in follow-up; delta = calculated change (pre-post); EF = ejection fraction; EDV = end-diastolic volume (ml); ESV = end-systolic volume (ml); MM = myocardial mass (g/m²); LVIDs = left ventricle end-systolic diameter (mm); p = statistical significance.

Conclusion: Our results confirmed LV positive remodeling after AVR due to chronic AR, indicating that initial LVEF prior AVR could predict residual LV dilatation despite the reduction in EDV after AVR. In patients with LVEF>60% preoperatively, reversible positive remodeling after AVR may occur with complete normalization of ESV/EDV and LVIDs values during FU.

LITERATURE

Vollema EM, Singh GK, Prihadi EA, Regeer MV, Ewe SH, Ng ACT, et al. Time course of left ventricular remodelling and mechanics after aortic valve surgery: aortic stenosis vs. aortic regurgitation. Eur Heart J Cardiovasc Imaging. 2019 October 1;20(10):1105–11. https://doi.org/10.1093/ehjci/jez049 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/30932153

Zhang MK, Li LN, Xue H, Tang XJ, Sun H, Wu QY. Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement. J Cardiothorac Surg. 2022 January 16;17(1):8. https://doi.org/10.1186/s13019-022-01754-5 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/35034651

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Cardiologia Croatica, Vol. 19 No. 11-12, 2024.

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KEYWORDS:

Reversible left ventricle remodeling after surgical treatment for severe aortic regurgitation is related to near - normal ejection fraction prior to aortic valve surgery

LITERATURE