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Reverse left ventricular remodeling after aortic valve replacement for aortic stenosis: systematic review and meta-analysis
Session:
Comunicações Orais (Sessão 3) - Doença valvular
Speaker:
Fábio Sousa Nunes
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.7 Valvular Heart Disease - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Fábio Sousa Nunes; Catarina Marques; André Beco; João Ricardo Silva; Miguel Carvalho; Bernardo Sousa Pinto; Francisca Saraiva; Adelino Leite Moreira; Carla Sousa; Filipe Macedo
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Reverse Left Ventricle (LV) remodeling after Aortic Valve Replacement (AVR), in patients with aortic stenosis, is well documented as an important prognostic factor. With this systematic review and meta-analysis, we aimed to characterize the response of the unloaded LV after AVR.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: We searched on MEDLINE/PubMed, Web of Science, and Embase for studies reporting echocardiographic findings before and at least 1 month after AVR for the treatment of aortic stenosis. 4493 abstracts were screened for inclusion. Main factors of interest were structural and dynamic measures of the LV after AVR. We performed a random-effects meta-analysis to compute standardized mean differences (SMD) between follow-up and baseline values for each outcome.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: 33 studies met the eligibility criteria, yielding 2368 patients. AVR resulted in reduced mean aortic gradient (SMD: -41.9mmHg, 95% CI: -44.0 to -39.8, I2 = 95.8%), LV Mass (for surgical AVR, SMD: -84.4g, 95% CI: -103.3 to -65.5, I2 = 73.8%; whereas for transcatheter AVR, SMD – 18.5g, 95% CI -30.2 to – 6.8, I2 = 0%, see image), End-Diastolic LV Diameter (SMD: -1.95 mm, 95% CI: -3.0 to -0.9, I2 = 89.4%), End-Diastolic LV Volume (SMD: -13.0mL, 95% CI: -18.6 to -7.4, I2 = 49.8%). LV Ejection Fraction increased after AVR, particularly for patients with baseline decreased LVEF (SMD: +9.5%, 95% CI 8 – 11.1%, I2 = 31.9%). Notably, there was no significant interaction of follow-up time in LV mass, End-Diastolic LV Diameter and End-Diastolic LV volume, suggesting that LV reverse remodeling occurs in the first months after AVR, with few changes thereafter.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusions: This is the largest systematic review and meta-analysis on LV reverse remodeling after AVR for aortic stenosis. This review presents the expected changes in echocardiographic LV parameters for various timepoints, which may be helpful for the follow up of the typical AVR patient. Notably, this review suggests that LV reverse remodeling occurs in the first months after AVR, with few changes thereafter.</span></span></p>
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