Noninvasive estimate of left ventricular filling pressure correlated with early and midterm postoperative cardiovascular events after isolated aortic valve replacement in patients with severe aortic stenosis

Objectives: The aim of this study was to investigate whether preoperative estimated left ventricular filling pressure predicts the postoperative outcome in patients with severe aortic stenosis. Methods: Two hundred ten patients who underwent isolated aortic valve replacement because of severe aortic stenosis were analyzed. Left ventricular filling pressure was noninvasively assessed based on the ratio between early diastolic mitral inflow and mitral annular velocity (E/E′), which was calculated based on results of mitral inflow and mitral annular tissue Doppler scanning. Early postoperative hospital events were reviewed. Postoperative mortality and morbidity were searched and compared according to left ventricular filling pressure. Results: Preoperative functional class was associated with increased E/E′ values. Postoperative hospital events were higher in patients with increased preoperative E/E′ values. Midterm mortality of the overall population was very low after aortic valve replacement (2%). Cardiovascular event-free survival, including hospital visits caused by heart failure symptoms, embolic cerebral infarction, and sudden cardiac death, was significantly lower in the patients with increased left ventricular filling pressure and E/E′ values of greater than 12 (P = .03). Multivariable analysis showed a high hazard ratio of increased E/E′ values of greater than 12 (hazard ratio, 41; P < .001). Conclusions: The incidence of postoperative mortality after isolated aortic valve replacement caused by severe aortic stenosis is relatively low in the current era. E/E′ representing diastolic filling pressure is the most important preoperative predictor of risk of early postoperative hospital course and postoperative morbidity.