Jinghao Nicholas Ngiam1, Benjamin Yong-Qiang Tan1, Ching-Hui Sia1, Glenn K M Lee1, William K F Kong2, Yiong-Huak Chan3, Kian-Keong Poh2,4. 1. University Medicine Cluster, National University Health System, Singapore. 2. Department of Cardiology, National University Heart Center Singapore, Singapore. 3. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 4. Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Abstract
BACKGROUND/ OBJECTIVES: In severe aortic stenosis (AS), deterioration of left ventricular ejection fraction (LVEF) to <50% is an AHA/ACC class I indication for valve replacement, regardless of symptoms. Controversy surrounds prognosis of low-flow AS compared to normal-flow, and no study has examined LVEF deterioration. We compared factors associated with LVEF deterioration (to <50%) and clinical outcomes. METHODS: Consecutive subjects with low-flow (stroke volume index <35 mL/m2 , n=56) and normal-flow (n=72) severe AS (aortic valve area <1 cm2 ) with preserved LVEF (>50%) and with paired echocardiography were studied. Univariate and multivariate analyses identified factors associated with LVEF deterioration. Clinical outcomes were determined on follow-up for more than 5 years. RESULTS: Significant LVEF deterioration (to <50%) was seen in 18% of low-flow (initial LVEF 63±8% to 32±9%) and 18% of normal-flow AS (61±7% to 31±12%). Independent factors in low-flow AS were hypertension (OR: 30.7, 95% CI: 2.0-467.6, P=.014) and higher end-systolic wall stress (OR: 1.086, 95% CI: 1.022-1.153, P=.008), compared to normal-flow, which were hypertension (OR: 15.9, 95% CI: 3.1-81.9, P=.001), higher septal E/E' ratio (OR: 1.16, 95% CI: 1.01-1.35, P=.043), lower septal S' velocity (OR: 0.204, 95% CI: 0.061-0.682, P=.010), and higher end-systolic wall stress (OR: 1.051, 95% CI: 1.001-1.104, P=.047). Overall, a third of the cohort experienced MACE, regardless of flow (log-rank 0.048, P=.827). However, aortic valve replacement (AVR) rates were lower in low-flow AS (20% vs 43%, P=.005). CONCLUSIONS: Low-flow AS despite normal LVEF appears similar to normal-flow in terms of LVEF deterioration and clinical outcomes in our Asian population. AVR rate was lower even though low-flow may not reflect less severe disease.
BACKGROUND/ OBJECTIVES: In severe aortic stenosis (AS), deterioration of left ventricular ejection fraction (LVEF) to <50% is an AHA/ACC class I indication for valve replacement, regardless of symptoms. Controversy surrounds prognosis of low-flow AS compared to normal-flow, and no study has examined LVEF deterioration. We compared factors associated with LVEF deterioration (to <50%) and clinical outcomes. METHODS: Consecutive subjects with low-flow (stroke volume index <35 mL/m2 , n=56) and normal-flow (n=72) severe AS (aortic valve area <1 cm2 ) with preserved LVEF (>50%) and with paired echocardiography were studied. Univariate and multivariate analyses identified factors associated with LVEF deterioration. Clinical outcomes were determined on follow-up for more than 5 years. RESULTS: Significant LVEF deterioration (to <50%) was seen in 18% of low-flow (initial LVEF 63±8% to 32±9%) and 18% of normal-flow AS (61±7% to 31±12%). Independent factors in low-flow AS were hypertension (OR: 30.7, 95% CI: 2.0-467.6, P=.014) and higher end-systolic wall stress (OR: 1.086, 95% CI: 1.022-1.153, P=.008), compared to normal-flow, which were hypertension (OR: 15.9, 95% CI: 3.1-81.9, P=.001), higher septal E/E' ratio (OR: 1.16, 95% CI: 1.01-1.35, P=.043), lower septal S' velocity (OR: 0.204, 95% CI: 0.061-0.682, P=.010), and higher end-systolic wall stress (OR: 1.051, 95% CI: 1.001-1.104, P=.047). Overall, a third of the cohort experienced MACE, regardless of flow (log-rank 0.048, P=.827). However, aortic valve replacement (AVR) rates were lower in low-flow AS (20% vs 43%, P=.005). CONCLUSIONS: Low-flow AS despite normal LVEF appears similar to normal-flow in terms of LVEF deterioration and clinical outcomes in our Asian population. AVR rate was lower even though low-flow may not reflect less severe disease.
Authors: Jinghao Nicholas Ngiam; Nicholas Chew; Rebecca Teng; Jonathan D Kochav; Stephanie M Kochav; Benjamin Yong-Qiang Tan; Hui Wen Sim; Ching-Hui Sia; William K F Kong; Edgar Lik Wui Tay; Tiong-Cheng Yeo; Kian-Keong Poh Journal: Int J Cardiovasc Imaging Date: 2019-11-27 Impact factor: 2.357
Authors: Nicholas W S Chew; Jinghao Nicholas Ngiam; Benjamin Yong-Qiang Tan; Ching-Hui Sia; Hui Wen Sim; Ivandito Kuntjoro; William K F Kong; Edgar L W Tay; Tiong-Cheng Yeo; Kian Keong Poh Journal: Int J Cardiovasc Imaging Date: 2020-01-02 Impact factor: 2.357