Regression of left ventricular hypertrophy after aortic valve replacement for severe aortic stenosis in patients enrolled in a cardiovascular rehabilitation programme

Aim: Traditionally, it has been considered that left ventricular hypertrophy regression in patients with aortic valve replacement for severe aortic stenosis is correlated with their postoperatory evolution. This study evaluates preoperatory features and postoperatory left ventricular mass regression in this category of patients.

Material and methods: 46 patients with severe aortic stenosis of different etiologies were included and were investigated preoperatory and postoperatory at one month, three months and respectively one year after the surgery. The following transthoracic echocardiographic determinations were performed: left ventricular dimensions, interventricular septal thickness, posterior left ventricular wall thickness and left ventricular mass index. The stage of heart failure according to the NYHA functional classification system was evaluated preoperatory and postoperatory.

Results and discussions: There was a predominance of men (60.86%), with aortic degenerative stenosis (69.56%) and the mean age was 67+9 years old. Three months after the surgery there was a significant reduction of mean left ventricular (LV) mass index from 206.96±76g/m² to 163.08±22g/m², p<0.01– premature regression, and one year after surgery the reduction of mean left ventricular (LV) mass index was of little significance (from 163.08±22g/m² to 141.44±11g/m², p<0.05). It was also assessed the effect of systemic arterial hypertension on left ventricular mass reduction. Patients with systemic arterial blood pressure higher then target values recommended in guidelines, had a slight left ventricular mass regression in the first 3 months, vs. normotensive patients. Regarding clinical assessment of the NYHA functional classification system, patients had improved one functional class in general and two functional classes infrequently.

Conclusions: Left ventricular mass regression and especially premature regression are strictly correlated with the grade of the preoperatory left ventricular hypertrophy. The factors that influence postoperatory results are represented by: age, NYHA functional class, the presence of systemic arterial hypertension, left ventricular ejection fraction and left ventricular mass index. Preoperatory and also postoperatory systemic arterial hypertension had a negative impact on left ventricular mass reduction, especially in the case of drug treatment failure to maintain systemic arterial blood pressure within an optimal range.