Jordi S Dahl1, Mackram F Eleid1, Hector I Michelena1, Christopher G Scott1, Rakesh M Suri1, Hartzell V Schaff1, Patricia A Pellikka2. 1. From the Division of Cardiovascular Diseases (J.S.D., M.F.E., H.I.M., P.A.P.), Division of Biostatistics (C.G.S.), and Division of Cardiovascular Surgery (R.M.S., H.V.S.), Mayo Clinic, Rochester, MN. 2. From the Division of Cardiovascular Diseases (J.S.D., M.F.E., H.I.M., P.A.P.), Division of Biostatistics (C.G.S.), and Division of Cardiovascular Surgery (R.M.S., H.V.S.), Mayo Clinic, Rochester, MN. pellikka.patricia@mayo.edu.
Abstract
BACKGROUND: In asymptomatic patients with severe aortic stenosis, guidelines recommend left ventricular ejection fraction (LVEF) of <50% as the threshold for referral for aortic valve replacement. We investigated the importance of LVEF on long-term outcome after aortic valve replacement in symptomatic and asymptomatic patients with severe aortic stenosis. METHODS AND RESULTS: We retrospectively identified 2017 patients with severe aortic stenosis (aortic valve area<1 cm(2), mean gradient≥40 mm Hg, or indexed aortic valve area<0.6 cm(2)/m(2)) who underwent surgical aortic valve replacement from January 1995 to June 2009. Patients were divided into 4 groups depending on preoperative LVEF (<50% in 300 [15%] patients, 50%-59% in 331 [17%], 60%-69% in 908 [45%], and ≥70% in 478 [24%]). During follow-up of 5.3±4.4 years, 1056 (52%) patients died. A decrease in mortality was observed with increasing LVEF, P<0.0001; 5-year mortality estimates (95% confidence interval) were 0.41 (0.35-0.47), LVEF<50%; 0.35 (0.29-0.41), LVEF 50% to 59%; 0.26 (0.23-0.29), LVEF 60% to 69%; and 0.22 (0.18-0.26), LVEF≥70%. Compared with patients with LVEF≥60%, patients with LVEF 50% to 59% had increased mortality (hazard ratio [HR], 1.58; P<0.001), with similar risk increase in both symptomatic (HR, 1.56; P<0.001) and asymptomatic patients (HR, 1.58; P=0.006). Correcting for risk factors, LV mass index, aortic valve area, and stroke volume index, LVEF was independently predictive of mortality (HR, 0.88 per 10%; P<0.001). When this analysis was repeated in the subset of 1333 patients without history of coronary artery disease, LVEF remained associated with mortality (HR, 0.90 per 10%; P=0.009). CONCLUSIONS: LVEF is a powerful predictor of outcome in patients with severe aortic stenosis undergoing aortic valve replacement, independent of the presence of valve-related symptoms.
BACKGROUND: In asymptomatic patients with severe aortic stenosis, guidelines recommend left ventricular ejection fraction (LVEF) of <50% as the threshold for referral for aortic valve replacement. We investigated the importance of LVEF on long-term outcome after aortic valve replacement in symptomatic and asymptomatic patients with severe aortic stenosis. METHODS AND RESULTS: We retrospectively identified 2017 patients with severe aortic stenosis (aortic valve area<1 cm(2), mean gradient≥40 mm Hg, or indexed aortic valve area<0.6 cm(2)/m(2)) who underwent surgical aortic valve replacement from January 1995 to June 2009. Patients were divided into 4 groups depending on preoperative LVEF (<50% in 300 [15%] patients, 50%-59% in 331 [17%], 60%-69% in 908 [45%], and ≥70% in 478 [24%]). During follow-up of 5.3±4.4 years, 1056 (52%) patients died. A decrease in mortality was observed with increasing LVEF, P<0.0001; 5-year mortality estimates (95% confidence interval) were 0.41 (0.35-0.47), LVEF<50%; 0.35 (0.29-0.41), LVEF 50% to 59%; 0.26 (0.23-0.29), LVEF 60% to 69%; and 0.22 (0.18-0.26), LVEF≥70%. Compared with patients with LVEF≥60%, patients with LVEF 50% to 59% had increased mortality (hazard ratio [HR], 1.58; P<0.001), with similar risk increase in both symptomatic (HR, 1.56; P<0.001) and asymptomatic patients (HR, 1.58; P=0.006). Correcting for risk factors, LV mass index, aortic valve area, and stroke volume index, LVEF was independently predictive of mortality (HR, 0.88 per 10%; P<0.001). When this analysis was repeated in the subset of 1333 patients without history of coronary artery disease, LVEF remained associated with mortality (HR, 0.90 per 10%; P=0.009). CONCLUSIONS: LVEF is a powerful predictor of outcome in patients with severe aortic stenosis undergoing aortic valve replacement, independent of the presence of valve-related symptoms.
Authors: Brian R Lindman; Marie-Annick Clavel; Patrick Mathieu; Bernard Iung; Patrizio Lancellotti; Catherine M Otto; Philippe Pibarot Journal: Nat Rev Dis Primers Date: 2016-03-03 Impact factor: 52.329
Authors: Thomas A Treibel; Rebecca Kozor; Marianna Fontana; Camilla Torlasco; Patricia Reant; Sveeta Badiani; Maria Espinoza; John Yap; Javier Diez; Alun D Hughes; Guy Lloyd; James C Moon Journal: JACC Cardiovasc Imaging Date: 2017-11-15
Authors: Ernest Spitzer; Ben Ren; Herbert Kroon; Lennart van Gils; Olivier Manintveld; Joost Daemen; Felix Zijlstra; Peter P de Jaegere; Marcel L Geleijnse; Nicolas M Van Mieghem Journal: Front Cardiovasc Med Date: 2018-08-17
Authors: Laura E Dobson; Tarique A Musa; Akhlaque Uddin; Timothy A Fairbairn; Owen J Bebb; Peter P Swoboda; Philip Haaf; James Foley; Pankaj Garg; Graham J Fent; Christopher J Malkin; Daniel J Blackman; Sven Plein; John P Greenwood Journal: J Cardiovasc Magn Reson Date: 2017-02-22 Impact factor: 5.364
Authors: Mark A Peterzan; William T Clarke; Craig A Lygate; Hannah A Lake; Justin Y C Lau; Jack J Miller; Errin Johnson; Jennifer J Rayner; Moritz J Hundertmark; Rana Sayeed; Mario Petrou; George Krasopoulos; Vivek Srivastava; Stefan Neubauer; Christopher T Rodgers; Oliver J Rider Journal: Circulation Date: 2020-05-22 Impact factor: 29.690