Residual left ventricular hypertrophy with adverse clinical outcomes in patients with severe aortic stenosis and asymmetric septal hypertrophy after aortic valve replacement

Abstract

Objectives: The aim of this study is to describe the temporal pattern of left atrial (LA) and left ventricular (LV) reverse remodelling and to evaluate the impact of residual LV hypertrophy on the prognosis of patients with severe aortic stenosis and asymmetric septal hypertrophy undergoing aortic valve replacement (AVR). Methods: We retrospectively reviewed 59 consecutive patients who underwent AVR for severe aortic stenosis and asymmetric septal hypertrophy. They were divided into the normal LV mass group and the residual LV hypertrophy group according to the LV mass index (LVMI) 2 years after AVR. Thirty patients were eligible for analysis of the time-dependent changes in LA and LV reverse remodelling. Results: The interventricular septal thickness and LVMI gradually decreased and reached their lowest points 2 years after operation, whereas the LA dimension rapidly decreased in the early postoperative period and plateaued at 3 months. The multivariable analysis revealed a higher preoperative LVMI [odds ratio 6.36 (1.678-24.11); P = 0.007] as an independent predictor of residual hypertrophy 2 years after operation. The Cox proportional hazards model showed that a higher postoperative peak velocity [hazard ratio 6.715 (1.405-32.104); P = 0.017] was an independent predictor of long-term non-fatal cardiovascular hospitalization. Patients with residual hypertrophy 2 years after AVR had a higher rate of non-fatal cardiovascular hospitalization (P = 0.014). Conclusions: For patients with severe aortic stenosis and asymmetric septal hypertrophy, maximum LA recovery occurred 3 months after AVR, whereas maximum LV recovery occurred 2 years thereafter. A higher preoperative LVMI may lead to postoperative residual hypertrophy, which is associated with adverse clinical outcomes.