Prognostic Impact of 1-Year Left Ventricular Mass Regression After Aortic Valve Surgery in Severe Aortic Regurgitation

BACKGROUND AND OBJECTIVES: Left ventricular reverse remodeling (LVRR) following aortic valve surgery has been associated with improved outcomes in chronic aortic regurgitation (AR), yet its definition remains controversial. This study evaluated the prognostic impact of LVRR using the degree of left ventricular mass index (LVMi) reduction. METHODS: We retrospectively analyzed patients undergoing surgery for severe AR at Asan Medical Center between January 2006 and December 2020. LVRR was determined by the degree of LVMi regression at 1 year postoperatively. Patients were categorized into greater (n=315) or lesser (n=248) regression groups based on time-dependent receiver operating characteristic curve analysis. The primary endpoint was a composite of all-cause mortality and rehospitalization due to heart failure (HF). RESULTS: Over a median follow-up of 7.58 years, 29 patients (9.2%) in the greater regression group and 51 (20.6%) in the lesser regression group experienced the primary endpoint. Multivariate Cox regression analysis revealed that the greater regression group had a lower risk of mortality or HF rehospitalization (hazard ratio, 0.44; 95% confidence interval, 0.27-0.72). Further analyses identified hypertension as the only clinical predictor of reduced LVRR, while smaller left atrial diameter, larger baseline LVMi, and higher left ventricular ejection fraction were independent echocardiographic predictors of greater LVRR. CONCLUSIONS: Greater 1-year postoperative LVMi regression was associated with improved outcomes in chronic AR, particularly by reducing HF-related hospitalizations. While hypertension negatively affected remodeling, favorable baseline echocardiographic profiles, including higher LVMi, preserved left ventricular ejection fraction, and a smaller left atrium, were connected to more significant postoperative LVRR.