초록접수 현황
| 15F-020 | 포럼 발표 |
Impact of Left Ventricular Diastolic Dysfunction in Patients with Chronic Severe Aortic Regurgitation Undergoing Aortic Valve Replacement
김영웅, 김완기, 정성호, 주석중, 정철현, 이재원, 김준범
울산대학교 의과대학 서울아산병원 흉부외과학교실
Background : Little is known about the effect of LV diastolic function in severe aortic regurgitation (AR).
Methods : We evaluated 218 patients (mean age, 52.8±14.5 years; 75 females) undergoing aortic valve replacement for chronic severe AR from 2005 to 2015. Early diastolic mitral annular velocity (e’) was measured using tissue doppler echocardiography in all patients. LV diastolic dysfunction was defined as ‘peak early LV diastolic inflow velocity’ divided by e’ (E/e’ ratio) of >15.
Results : 70 patients (32.1%) had LV diastolic dysfunction, preoperatively. Age (γ=0.14, P=0.032), atrial fibrillation (γ=0.21, P=0.002), left atrial size (γ=0.30, P<0.001), LV end-systolic and diastolic volumes (P=0.010 and 0.001, respectively), and tricuspid regurgitant velocity (γ=0.47, P<0.001) were significantly correlated with the E/e’ ratio. There was one (0.5%) in-hospital mortality. During a mean follow-up period of 44.2±34.3 months, 10 patients (4.6%) died and 7 patients experienced major adverse events including readmission for congestive heart failure in 2 cases, stroke in 4 and infective endocarditis in 1. On Cox regression analysis, age (HR, 1.08; 95% CI, 1.00-1.16; P=0.056) and E/e’ ratio (HR, 1.11; 95% CI, 1.04-1.19; P=0.003) emerged as independent predictors of mortality while E/e’ ratio was the only significant and independent factor of composite adverse outcomes (HR, 1.06; 95% CI, 1.02-1.11; P=0.008). Receiver operating curves assessing the ability of LV diastolic function to predict adverse outcomes showed an area under the curve of 0.71 (95% CI 0.52-0.90, P=0.032), with a best accuracy at 15.9 (sensitivity 66.7%, specificity 70.3%). Overall survival at 5 years was significantly superior in patients with preserved LV diastolic function compared with those with LV diastolic dysfunction (98.3±1.2% vs. 89.3±4.7%, P=0.028) as were for event-free survival (93.7±2.7% vs. 81.6±5.7%, P=0.010; Figure).
Conclusion : The LV diastolic dysfunction was common in patients with severe chronic AR, and was significantly associated with increased risk of adverse clinical outcomes.
Methods : We evaluated 218 patients (mean age, 52.8±14.5 years; 75 females) undergoing aortic valve replacement for chronic severe AR from 2005 to 2015. Early diastolic mitral annular velocity (e’) was measured using tissue doppler echocardiography in all patients. LV diastolic dysfunction was defined as ‘peak early LV diastolic inflow velocity’ divided by e’ (E/e’ ratio) of >15.
Results : 70 patients (32.1%) had LV diastolic dysfunction, preoperatively. Age (γ=0.14, P=0.032), atrial fibrillation (γ=0.21, P=0.002), left atrial size (γ=0.30, P<0.001), LV end-systolic and diastolic volumes (P=0.010 and 0.001, respectively), and tricuspid regurgitant velocity (γ=0.47, P<0.001) were significantly correlated with the E/e’ ratio. There was one (0.5%) in-hospital mortality. During a mean follow-up period of 44.2±34.3 months, 10 patients (4.6%) died and 7 patients experienced major adverse events including readmission for congestive heart failure in 2 cases, stroke in 4 and infective endocarditis in 1. On Cox regression analysis, age (HR, 1.08; 95% CI, 1.00-1.16; P=0.056) and E/e’ ratio (HR, 1.11; 95% CI, 1.04-1.19; P=0.003) emerged as independent predictors of mortality while E/e’ ratio was the only significant and independent factor of composite adverse outcomes (HR, 1.06; 95% CI, 1.02-1.11; P=0.008). Receiver operating curves assessing the ability of LV diastolic function to predict adverse outcomes showed an area under the curve of 0.71 (95% CI 0.52-0.90, P=0.032), with a best accuracy at 15.9 (sensitivity 66.7%, specificity 70.3%). Overall survival at 5 years was significantly superior in patients with preserved LV diastolic function compared with those with LV diastolic dysfunction (98.3±1.2% vs. 89.3±4.7%, P=0.028) as were for event-free survival (93.7±2.7% vs. 81.6±5.7%, P=0.010; Figure).
Conclusion : The LV diastolic dysfunction was common in patients with severe chronic AR, and was significantly associated with increased risk of adverse clinical outcomes.
책임저자: 김준범
울산대학교 의과대학 서울아산병원 흉부외과학교실
연락처 : 김영웅, Tel: 010-2997-7975 , E-mail : winterreise.kim@gmail.com
