{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T09:33:13Z","timestamp":1762075993415,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,19]],"date-time":"2022-11-19T00:00:00Z","timestamp":1668816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Chronic severe aortic valve disease is associated with important changes in left ventricle (LV) performance associated with eccentric or concentric LV hypertrophy. We aimed to assess the immediate prognostic implications of the type of the LV diastolic filling pattern (LVDFP) compared with LV systolic performance in patients with severe aortic regurgitation (AR) undergoing aortic valve replacement (AVR) and to define the independent echographic predictors for the immediate and long-term prognoses. Materials and Methods: We performed a prospective study enrolling 332 AR patients undergoing AVR, divided into two groups: Group A\u2014201 pts with normal LV systolic function, divided into two subgroups (A1: 129 pts with a nonrestrictive LVDFP and A2: 72 pts with restrictive LVDFP), and Group B\u2014131 pts with LV systolic dysfunction (LV ejection fraction LVEF &lt; 50%), divided into two subgroups (B1: 83 pts with a nonrestrictive LVDFP and B2: 48 pts with restrictive LVDFP). Results: The early postoperative mortality rate was higher in patients with a restrictive LVDFP (11.12% in A2 and 12.5% in B2) compared with normal LV filling (2.32% in A1 and 7.63% in B1, p &lt; 0.0001), regardless of the LVEF. The restrictive LVDFP\u2014defined by at least one of the following echographic parameters: an E\/A &gt; 2 with an E wave deceleration time (EDt) &lt; 100 ms; an isovolumetric relaxation time (IVRT) &lt; 60 ms; or an S\/D ratio &lt; 1 in the pulmonary vein flow\u2014was an independent predictor for early postoperative mortality, increasing the relative risk by 8.2-fold. Other independent factors associated with early poor prognosis were an LV end-systolic diameter (LVESD) &gt; 58 mm, an age &gt; 75 years, and the presence of comorbidities (chronic obstructive pulmonary disease-COPD or diabetes mellitus). On a medium-term, an unfavorable evolution was associated with: an age &gt; 75 years (RR = 8.1), an LV end-systolic volume (LVESV) &gt; 95 cm3 (RR = 6.7), a restrictive LVDFP (RR = 9.8, p &lt; 0.0002), and pulmonary hypertension (RR = 8.2). Conclusions: The presence of a restrictive LVDFP in patients with AR undergoing AVR is associated with both increased early and medium-term mortality rates. The LV diastolic function is a more reliable parameter for prognosis than LV systolic performance (RR 9.2 versus 2.1). Other independent predictors for increased early postoperative mortality rate were: an age &gt; 75 years, an LVESD &gt; 58 mm, and comorbidities (diabetes mellitus, COPD), and for unfavorable evolution at 2 years postoperatively: an age &gt; 75 years, an LVESV &gt; 95 cm3, and severe pulmonary hypertension.<\/jats:p>","DOI":"10.3390\/medicina58111676","type":"journal-article","created":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T03:07:23Z","timestamp":1669000043000},"page":"1676","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Diastolic versus Systolic Left Ventricular Dysfunction as Independent Predictors for Unfavorable Postoperative Evolution in Patients with Aortic Regurgitation Undergoing Aortic Valve Replacement"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1439-5002","authenticated-orcid":false,"given":"Luminita","family":"Iliuta","sequence":"first","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"},{"name":"Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5590-7879","authenticated-orcid":false,"given":"Andreea Gabriella","family":"Andronesi","sequence":"additional","affiliation":[{"name":"Nephrology Department, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"},{"name":"Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6837-260X","authenticated-orcid":false,"given":"Camelia Cristina","family":"Diaconu","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"},{"name":"Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"},{"name":"Academy of Romanian Scientists, 3 Ilfov Street, 050044 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horatiu","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Academy of Romanian Scientists, 3 Ilfov Street, 050044 Bucharest, Romania"},{"name":"Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5239-9792","authenticated-orcid":false,"given":"Marius","family":"Rac-Albu","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"},{"name":"Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madalina-Elena","family":"Rac-Albu","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.athoracsur.2018.03.034","article-title":"Left Ventricular Diastolic Function After Aortic Valve Replacement for Chronic Aortic Regurgitation","volume":"106","author":"Ma","year":"2018","journal-title":"Ann. 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