OBJECTIVES: This study sought to determine the prevalence, characteristics, and outcomes of asymptomatic left ventricular (LV) systolic dysfunction in patients with severe aortic stenosis (AS). BACKGROUND: Management of asymptomatic patients with severe AS remains controversial. In these patients, LV systolic dysfunction, defined in the guidelines as ejection fraction <50%, is a Class I(C) indication for aortic valve replacement (AVR), but its prevalence is unknown. METHODS: A retrospective study of adults ≥40 years of age with severe valvular AS (peak velocity ≥4 m/s, mean gradient >40 mm Hg, aortic valve area [AVA] <1 cm(2), or AVA index <0.6 cm(2)/m(2)) from 1984 to 2010 was undertaken. Patients with prior cardiac surgery, severe coronary artery disease, or greater than moderate aortic regurgitation were excluded. RESULTS: Of 9,940 patients with severe AS, 43 (0.4%) patients had asymptomatic LV dysfunction. Age was 73 ± 14 years and 70% were male. Hypertension (78%) and LV hypertrophy (LV mass index 143 ± 36 g/m(2)) were characteristic. Fifty-three percent of these patients developed symptoms at 21 ± 19 months after diagnosis. During 7.5 ± 6.7-year follow-up, 5-year mortality was 48%. After multivariable adjustment, there was no survival advantage with AVR in asymptomatic, severe AS with LV dysfunction (p = 0.51). CONCLUSIONS: In severe AS, the prevalence of asymptomatic LV systolic dysfunction is 0.4%. Despite an asymptomatic clinical status, patients with severe AS and LV ejection fraction <50% have a poor prognosis, with or without AVR.
OBJECTIVES: This study sought to determine the prevalence, characteristics, and outcomes of asymptomatic left ventricular (LV) systolic dysfunction in patients with severe aortic stenosis (AS). BACKGROUND: Management of asymptomatic patients with severe AS remains controversial. In these patients, LV systolic dysfunction, defined in the guidelines as ejection fraction <50%, is a Class I(C) indication for aortic valve replacement (AVR), but its prevalence is unknown. METHODS: A retrospective study of adults ≥40 years of age with severe valvular AS (peak velocity ≥4 m/s, mean gradient >40 mm Hg, aortic valve area [AVA] <1 cm(2), or AVA index <0.6 cm(2)/m(2)) from 1984 to 2010 was undertaken. Patients with prior cardiac surgery, severe coronary artery disease, or greater than moderate aortic regurgitation were excluded. RESULTS: Of 9,940 patients with severe AS, 43 (0.4%) patients had asymptomatic LV dysfunction. Age was 73 ± 14 years and 70% were male. Hypertension (78%) and LV hypertrophy (LV mass index 143 ± 36 g/m(2)) were characteristic. Fifty-three percent of these patients developed symptoms at 21 ± 19 months after diagnosis. During 7.5 ± 6.7-year follow-up, 5-year mortality was 48%. After multivariable adjustment, there was no survival advantage with AVR in asymptomatic, severe AS with LV dysfunction (p = 0.51). CONCLUSIONS: In severe AS, the prevalence of asymptomatic LV systolic dysfunction is 0.4%. Despite an asymptomatic clinical status, patients with severe AS and LV ejection fraction <50% have a poor prognosis, with or without AVR.
Authors: Alec Vahanian; Helmut Baumgartner; Jeroen Bax; Eric Butchart; Robert Dion; Gerasimos Filippatos; Frank Flachskampf; Roger Hall; Bernard Iung; Jaroslaw Kasprzak; Patrick Nataf; Pilar Tornos; Lucia Torracca; Arnold Wenink Journal: Eur Heart J Date: 2007-01-26 Impact factor: 29.983
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Authors: Patricia A Pellikka; Maurice E Sarano; Rick A Nishimura; Joseph F Malouf; Kent R Bailey; Christopher G Scott; Marion E Barnes; A Jamil Tajik Journal: Circulation Date: 2005-06-13 Impact factor: 29.690
Authors: Robert O Bonow; Blase A Carabello; Kanu Chatterjee; Antonio C de Leon; David P Faxon; Michael D Freed; William H Gaasch; Bruce W Lytle; Rick A Nishimura; Patrick T O'Gara; Robert A O'Rourke; Catherine M Otto; Pravin M Shah; Jack S Shanewise Journal: Circulation Date: 2008-09-26 Impact factor: 29.690
Authors: Morgan L Brown; Patricia A Pellikka; Hartzell V Schaff; Christopher G Scott; Charles J Mullany; Thoralf M Sundt; Joseph A Dearani; Richard C Daly; Thomas A Orszulak Journal: J Thorac Cardiovasc Surg Date: 2007-12-26 Impact factor: 5.209
Authors: Anthony N DeMaria; Jeroen J Bax; Gregory K Feld; Barry H Greenberg; Jennifer L Hall; Mark A Hlatky; Wilbur Y W Lew; João A C Lima; Ehtisham Mahmud; Alan S Maisel; Sanjiv M Narayan; Steven E Nissen; David J Sahn; Sotirios Tsimikas Journal: J Am Coll Cardiol Date: 2013-01-22 Impact factor: 24.094