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Global longitudinal strain in prosthesis-patient mismatch

relation to left ventricular mass regression and outcomes

Zhang, Hong-weia,*; Gu, Juna,*; Xiao, Zheng-huaa,*; Li, Ya-jiaob; Yang, Penga; Huang, Yaoa; Lu, Chena; Zhang, Er-yonga; Hu, Jiaa

Journal of Cardiovascular Medicine: July 2019 - Volume 20 - Issue 7 - p 434–441
doi: 10.2459/JCM.0000000000000819
Research articles: Imaging
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Aims Aortic prosthesis-patient mismatch (PPM) increases left ventricular (LV) afterload and prevents LV mass regression (LVMR) after surgery. This study was designed to investigate the association between the baseline global longitudinal strain (GLS) and the postoperative LVMR, and its relation to adverse outcomes.

Methods A total of 316 patients with aortic stenosis undergoing isolated mechanical prosthesis implantation were screened, and data from 91 patients with aortic PPM and 165 non-PPM patients were retrospectively collected. All 256 patients underwent measurement of GLS by two-dimensional speckle-tracking echocardiography preoperatively, and were followed up for postoperative changes of LV mass index (LVMi) and other clinical outcomes.

Results During the follow-up, LVMi in PPM patients decreased significantly from 139.6 ± 20.8 to 119.6 ± 26.5 g/m2 (P < 0.001). These patients were divided into two groups according to the median value of the reduction rate of LVMi at final follow-up, and preoperative GLS markedly decreased in PPM patients with insignificant reduction in LVMi. Multivariate analysis identified preoperative GLS (odds ratio 3.45, 95% confidence interval 1.27–11.05, P = 0.002) and preoperative LVMi (odds ratio 2.87, 95% confidence interval 1.21–8.13, P = 0.012) as independently associated with an insignificant LVMR. Moreover, PPM patients with limited reduction in LVMi were at an increased risk of cardiac death and major adverse valve-related events.

Conclusion In patients with aortic PPM early after surgery, reduced preoperative GLS could be a novel sensitive risk factor for a limited regression of LV hypertrophy, and this is associated with an increased risk of adverse events in PPM patients.

aDepartment of Cardiovascular Surgery

bDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, China

Correspondence to Jia Hu, Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guo Xue Alley 37#, Chengdu 610041, China Tel: +86 028 85421833; fax: +86 028 85421833; e-mail: humanjia@msn.com

Received 2 September, 2018

Revised 26 April, 2019

Accepted 26 April, 2019

© 2019 Italian Federation of Cardiology. All rights reserved.