ASSOCIATION OF LEFT VENTRICULAR DILATATION PATTERNS WITH MORTALITY IN PATIENTS WITH MODERATE AND MODERATE-SEVERE AORTIC REGURGITATION

Background: Recent studies suggested that in Aortic Regurgitation (AR) volumetric measures may better reflect Left Ventricular (LV) remodeling than linear dimensions. The aim of this study is to identify the differences in LV remodeling based on volumetric and linear measures and their association with outcome.
Methods: 904 patients (57 ± 18 years, 60% male) with moderate and moderate-severe AR were included and classified into 3 groups based on the presence of LV end-systolic volume index ≥45 ml/m2 and LV end-systolic diameter index ≥20 mm/m2: normal, discordant dilatation (one positive criterion) and concordant dilatation (Fig 1a). The primary endpoint was all-cause mortality (153, 17%).
Results: In multivariate analysis, age (HR 1.06, 95% CI 1.05-1.07, p<0.001), NYHA class 3-4 (HR 1.7, 95%CI 1.15-2.65, p=0.009), LVEF ≤55% (HR 1.7, 95% CI 1.15-2.43, p=0.006), time-dependent aortic valve surgery (AVS) (HR 0.54, 95% CI 0.36-0.8, p=0.002) and the presence of discordant (HR 1.62, 95%CI 1.05-2.5, p=0.029) or concordant dilatation (HR 2.7, 95% CI 1.7 to 4.3, p<0.001) were associated with outcome. Concordant dilatation showed worse survival (Fig 1b), but benefited more from AVS based on a landmark analysis (p<0.001).
Conclusion: In moderate and moderate-severe AR, the presence of LV dilatation documented by linear and/or volumetric methods was independently associated with increased mortality. Combining both methods for assessment of LV remodeling may improve risk stratification of these patients.