Valvular Cardiomyopathy Persists Postoperatively in Aortic Regurgitation Patients: Data from cMRI-Based Cohort Study

Background: Aortic valve regurgitation leads to a volume overload of the left ventricle, which results in potentially irreversible structural and functional changes in the myocardial architecture. In our study, we aimed to investigate the progress of valvular cardiomyopathy in aortic regurgitation (AR) patients following aortic valve surgery.

Method: We conducted a prospective cohort study which included all consecutive patients, referred to our institution for elective aortic valve surgery for AR. Patient with functional mitral regurgitation (FMR) who underwent mitral valve surgery were used as control cohort.

Further inclusion criteria were (1) preoperative cardiac examination by cardiac magnetic resonance imaging (cMRI) with assessment of native T1 values, (2) preoperative, and (3) 6-month postoperative 2D transthoracic echocardiography with assessment of indexed left ventricular end-diastolic volume (iLVEDV) and indexed left ventricular end-systolic volume (iLVESV). Difference of iLVEDV and iLVESV at six months follow-up versus at baseline was calculated as delta (∆) variable (i.e., follow-up value minus baseline value).

Results: A total of 79 consecutive patients (mean age 56 ± 14 years; 73.4% male) with severe AR (n = 46) or severe FMR (n = 33) were included. Operative procedures consisted of aortic valve repair (n = 30), aortic valve replacement (n = 16) and mitral valve repair (n = 33).

The control group had signs of more severe valvular cardiomyopathy than AR patients including higher values of native T1 (1,066 ± 39 millisecond vs. 1,032 ± 32 millisecond; p < 0.001), higher proportion of coronary artery disease (68 vs. 2%, p < 0.001) and higher values of proBNP (3,715 ± 3,483 ng/mL vs. 801 ± 1,633 ng/mL; p < 0.001).

Mean ∆iLVEDV improved significantly in AR versus FMR patients (−21 ± 22 mL vs. −10 ± 17 mL; p = 0.02). No differences were found between AR and FMR patients regarding postoperative ∆iLVESV (−8 ± 12 mL vs. −6 ± 16 mL; p = 0.5).

Conclusion: Valvular cardiomyopathy after surgery for AR and FMR did not resolve over a period of six months. While diastolic volume decreased significantly in AR versus FMR patients, left ventricular reverse remodeling defined as LVESV index did not differ between the groups. The pathophysiological background of systolic LV dysfunction in AR patients should be further clarified.

Publication History

Article published online:
03 February 2022