Reversal of residual left ventricular remodeling in corrected primary valvular regurgitation: is it different from dilated cardiomyopathy
R Zhang, Z Yang, N Qu, Y Xie, X Wang, Y Kang, Q ZhangAbstract
Background
Residual left ventricular (LV) remodeling, defined as persistent cardiac enlargement after surgical correction of severe primary valvular regurgitation, is associated with adverse long-term outcomes. While guideline-directed medical therapy (GDMT) has been proven to promote LV reverse remodeling (LVRR) in patients with new-onset dilated cardiomyopathy (DCM), the characteristics of LVRR after optimized medical therapy in patients with post-valvular correction residual remodeling, and its difference from that in new-onset DCM, remain unclear.
Purpose
This propensity score-matched cohort study aimed to compare the six-month LVRR and cardiac function recovery between patients with residual LV remodeling after corrected primary valvular regurgitation and those with new-onset DCM.
Methods
Patients with LVEF < 40% at baseline in two single-center cohorts were enrolled in this study. The ReReRe (Residual left ventricular Remodeling in corrected primary valvular Regurgitation) cohort included patients with residual left ventricular remodeling after primary valvular regurgitation correction, who received angiotensin receptor neprilysin inhibitor (ARNI)-based optimized medical therapy. And the New-onset DCM cohort enrolled patients diagnosed with DCM within sixth months, who received standard GDMT.
Results
After 1:1 propensity score matching of age, gender, and baseline LVEF, a total of 121 patients were included in each cohort. At baseline, the ReReRe cohort had a higher proportion of patients with NYHA class III/IV (40.5% vs. 6.6%) and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (1145.00 vs. 609.00 pg/mL), but smaller LVEDD (59.40 ± 10.15 vs. 65.66 ± 7.06 mm), LV end-diastolic volume (LVEDV) (222.45 ± 59.60 vs.152.87 ± 65.47 mm), and LV end-systolic volume (LVESV) (108.63 ± 56.98 vs. 154.12 ± 49.92 mm) (P < 0.05). After six-month follow-up, NYHA class has no difference between the two cohorts (P > 0.05), and the percentage of LVEDV change was larger in the ReReRe cohort (-30.08 ± 22.87% vs. -23.00 ± 20.36%, P < 0.05). Also, a higher LVEF was observed in the ReReRe cohort (LVEF ≥ 50%: 55.4% vs. 48.8%, 40% ≤ LVEF < 50%: 32.2% vs. 22.3%, P < 0.01). Meanwhile, more patients in the ReReRe cohort had their LVEDD restored to the normal level (LVEDD <55 mm [male] / <50 mm [female]).
Conclusions
In this propensity score-matched study, the ReReRe cohort achieved better cardiac function recovery and higher reduced scale of heart cavity volume at sixth month. These findings highlight the better reversibility of load-induced myocardial injury in this population, and call for early optimized medical therapy to address valvular heart disease management.