LV reverse remodeling imparted by aortic valve replacement for severe XXXX ; is it durable? A cardiovascular MRI study sponsored by the American Heart Association.

@entity1 @entity472 @entity64
BACKGROUND: In @entity1 with severe @entity472 ( @entity472 ), long-term data tracking surgically induced effects of afterload reduction on reverse LV remodeling are not available. Echocardiographic data is available short term, but in limited fashion beyond one year. Cardiovascular MRI (CMR) offers the ability to serially track changes in LV metrics with small numbers due to its inherent high spatial resolution and low variability. HYPOTHESIS: We hypothesize that changes in LV structure and function following aortic valve replacement (AVR) are detectable by CMR and once triggered by AVR, continue for an extended period. METHODS: Twenty-four @entity1 of which ten (67    12 years, 6 female) with severe, but compensated @entity472 underwent CMR pre-AVR, 6 months, 1 year and up to 4 years post-AVR. 3D LV mass index, volumetrics, LV geometry, and EF were measured. RESULTS: All @entity1 survived AVR and underwent CMR 4 serial CMR's. LVMI markedly decreased by 6 months (157    42 to 134    32 g/m2, p < 0.005) and continued trending downwards through 4 years (127    32 g/m2). Similarly, EF increased pre to post-AVR (55    22 to 65    11%,(p < 0.05)) and continued trending upwards, remaining stable through years 1-4 (66    11 vs. 65    9%). LVEDVI, initially high pre-AVR, decreased post-AVR (83    30 to 68    11 ml/m2, p < 0.05) trending even lower by year 4 (66    10 ml/m2). LV @entity64 volume increased rapidly from pre to post-AVR (40    11 to 44    7 ml, p < 0.05) continuing to increase non-significantly through 4 years (49    14 ml) with these LV metrics paralleling improvements in NYHA. However, LVmass/volume, a 3D measure of LV geometry, remained unchanged over 4 years. CONCLUSION: After initial beneficial effects imparted by AVR in severe @entity472 @entity1 , there are, as expected, marked improvements in LV reverse remodeling. Via CMR, surgically induced benefits to LV structure and function are durable and, unexpectedly express continued, albeit markedly incomplete improvement through 4 years post-AVR concordant with sustained improved clinical status. This supports down-regulation of both mRNA and MMP activity acutely with robust suppression long term.
