| Interaction and prognostic effects of left ventricular diastolic dysfunction and patient-prosthesis mismatch as determinants of outcome after isolated aortic valve replacement. | |
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MedLine Citation:
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PMID: 19699349 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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There are variable reported effects of patient-prosthesis mismatch (P-PM) on outcome. It was hypothesized that the adverse effect attributed to P-PM is actually due to left ventricular diastolic dysfunction (DD) in patients with small hearts. The aim of this study was therefore to determine the association among P-PM, DD, and outcomes. Doppler echocardiography was performed in 156 patients after aortic valve replacement. In vivo effective orifice areas for each prosthesis type and size were obtained from published references values of normally functioning prostheses. P-PM was identified from the predicted indexed orifice area, obtained by dividing the effective orifice area by body surface area. DD was classed as normal, delayed relaxation (prolonged deceleration time for age), or increased left atrial pressure (increased E/E' ratio, left atrial enlargement, short deceleration time). Events (cardiac-related hospitalizations and all-cause mortality after aortic valve replacement) were determined over a median follow-up periods of 3.5 years (interquartile range 2.1 to 5.7). P-PM was found in 91 patients (58%). Of the patients with P-PM, no DD was present on postoperative echocardiography in 15 patients (16%), delayed relaxation in 35 (39%), and increased left atrial pressure in 41 (45%). There were 61 total events (18 deaths and 43 hospitalizations): 4 (7%) in the no-DD group, 26 (42%) in the delayed relaxation group, and 31 (51%) in the increased left atrial pressure group. DD (p = 0.034) but not age (p = 0.09), the left ventricular ejection fraction (p = 0.60), or the presence of mismatch (p = 0.20) was associated with events. In conclusion, P-PM was associated with 14% mortality and a 39% composite event rate over 2-year follow-up. Events were significantly associated with DD. |
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Authors:
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Joseph Brown; Pallav Shah; Tony Stanton; Thomas H Marwick |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-06-24 |
Journal Detail:
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Title: The American journal of cardiology Volume: 104 ISSN: 1879-1913 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-08-24 Completed Date: 2009-09-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 707-12 Citation Subset: AIM; IM |
Affiliation:
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School of Medicine, University of Queensland, Brisbane, Australia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Aortic Valve Insufficiency / surgery Aortic Valve Stenosis / surgery Echocardiography, Doppler Female Heart Valve Prosthesis* Heart Valve Prosthesis Implantation* Humans Male Middle Aged Prognosis Prosthesis Fitting Treatment Outcome Ventricular Dysfunction, Left |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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