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Original Articles: Adult Cardiac

Influence of Concentric Left Ventricular Remodeling on Early Mortality After Aortic Valve Replacement

^a Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, Cleveland, Ohio
^b Department of Outcomes Research, Cleveland Clinic Foundation, Cleveland, Ohio
^c Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
^d Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
^e Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
^f Division of Non-Invasive Cardiac Imaging, Mount Sinai Heart, Departments of Medicine and Radiology, Mount Sinai School of Medicine, New York, New York

Accepted for publication February 25, 2008.

^_* Address correspondence to Dr Duncan, Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, 9500 Euclid Ave, G30, Cleveland, OH 44195 (Email: duncana{at}ccf.org).

Background: Severe left ventricular (LV) hypertrophy increases risk for adverse outcome after aortic valve replacement. Whether LV geometry influences mortality risk after aortic valve replacement is unclear. And, whether LV mass or relative wall thickness (RWT) better predicts risk for adverse postoperative outcomes is unknown. The purpose of this investigation was to examine the influence of LV geometry and LV hypertrophy on morbidity and in-hospital mortality after aortic valve replacement, and to determine whether LV mass or RWT had better prognostic ability.

Methods: Between January 1996 and June 2004, 5,083 patients underwent aortic valve replacement. Preoperative echocardiographic data was used to calculate LV mass and RWT. Left ventricular geometry was classified into one of four categories on the basis of LV mass indexed to body height and RWT: (1) concentric hypertrophy, (2) eccentric hypertrophy, (3) concentric remodeling, and (4) normal. Postoperative mortality and multisystem morbidities of patients with concentric geometries were compared to patients with nonconcentric geometries by propensity and logistic regression modeling. Also, prognostic ability of RWT and LV mass was compared.

Results: Nine hundred sixty-four patients with concentric geometry were propensity-matched to 964 patients with nonconcentric geometry. In-hospital mortality (38 [3.9%] versus 18 [1.9%]; p = 0.007), cardiac morbidity (33 [3.4%] versus 17 [1.8%]; p = 0.022), and prolonged intubation (85 [8.8%] versus 58 [6.0%]; p = 0.019) were higher in patients with concentric versus nonconcentric geometry. Increasing RWT, not LV mass, was associated with adverse outcomes.

Conclusions: Concentric geometries are associated with increased risk for in-hospital mortality after aortic valve replacement. Increased RWT is associated with adverse outcomes. Preoperative risk stratification should include assessments of LV hypertrophy and LV geometry.

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