BACKGROUND: Left ventricular ejection fraction (LVEF) is reduced in a subset of patients with severe aortic stenosis (AS). OBJECTIVES: The authors sought to determine the temporal course of reduced LVEF, its predictors, and its impact on prognosis in severe AS. METHODS: Serial echocardiograms of 928 consecutive patients with first-time diagnosis of severe AS (aortic valve area [AVA] ≤1 cm2) who had at least 1 echocardiogram before the diagnosis were evaluated. A total of 3,684 echocardiograms (median 3 studies per patient) within the preceding 10 years were analyzed. RESULTS: At the initial diagnosis, 196 (21%) patients had an LVEF <50% (35.1 ± 9.7%) and 732 (79%) had an LVEF ≥50% (64.2 ± 6.1%). LVEF deterioration had begun before AS became severe for those with an LVEF <50% and accelerated after AVA reached 1.2 cm2, whereas mean LVEF remained >60% in patients with LVEF ≥50% at initial diagnosis. The strongest predictor for LVEF deterioration was LVEF <60% at 3 years before AS became severe (odds ratio: 0.86; 95% confidence interval: 0.83 to 0.89; p < 0.001). During the median follow-up of 3.3 years, mortality was significantly worse, not only for patients with an LVEF <50%, but for patients with an LVEF of 50% ≤ LVEF <60% compared with patients with an LVEF ≥60% even after aortic valve replacement (p < 0.001). CONCLUSIONS: In patients with severe AS and reduced LVEF, a decline in LVEF began before AS became severe and accelerated after AVA reached 1.2 cm2. LVEF <60% in the presence of moderate AS predicts further deterioration of LVEF and appears to represent abnormal LVEF in AS.
BACKGROUND: Left ventricular ejection fraction (LVEF) is reduced in a subset of patients with severe aortic stenosis (AS). OBJECTIVES: The authors sought to determine the temporal course of reduced LVEF, its predictors, and its impact on prognosis in severe AS. METHODS: Serial echocardiograms of 928 consecutive patients with first-time diagnosis of severe AS (aortic valve area [AVA] ≤1 cm2) who had at least 1 echocardiogram before the diagnosis were evaluated. A total of 3,684 echocardiograms (median 3 studies per patient) within the preceding 10 years were analyzed. RESULTS: At the initial diagnosis, 196 (21%) patients had an LVEF <50% (35.1 ± 9.7%) and 732 (79%) had an LVEF ≥50% (64.2 ± 6.1%). LVEF deterioration had begun before AS became severe for those with an LVEF <50% and accelerated after AVA reached 1.2 cm2, whereas mean LVEF remained >60% in patients with LVEF ≥50% at initial diagnosis. The strongest predictor for LVEF deterioration was LVEF <60% at 3 years before AS became severe (odds ratio: 0.86; 95% confidence interval: 0.83 to 0.89; p < 0.001). During the median follow-up of 3.3 years, mortality was significantly worse, not only for patients with an LVEF <50%, but for patients with an LVEF of 50% ≤ LVEF <60% compared with patients with an LVEF ≥60% even after aortic valve replacement (p < 0.001). CONCLUSIONS: In patients with severe AS and reduced LVEF, a decline in LVEF began before AS became severe and accelerated after AVA reached 1.2 cm2. LVEF <60% in the presence of moderate AS predicts further deterioration of LVEF and appears to represent abnormal LVEF in AS.
Authors: Akhil Vaid; Kipp W Johnson; Marcus A Badgeley; Sulaiman S Somani; Mesude Bicak; Isotta Landi; Adam Russak; Shan Zhao; Matthew A Levin; Robert S Freeman; Alexander W Charney; Atul Kukar; Bette Kim; Tatyana Danilov; Stamatios Lerakis; Edgar Argulian; Jagat Narula; Girish N Nadkarni; Benjamin S Glicksberg Journal: JACC Cardiovasc Imaging Date: 2021-10-13
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: Ernest Spitzer; Rebecca T Hahn; Philippe Pibarot; Ton de Vries; Jeroen J Bax; Martin B Leon; Nicolas M Van Mieghem Journal: Card Fail Rev Date: 2019-05-24
Authors: Rasmus Carter-Storch; Nils Sofus Borg Mortensen; Nicolaj Lyhne Christensen; Mulham Ali; Kristian Bach Laursen; Patricia A Pellikka; Jacob Eifer Moller; Jordi S Dahl Journal: Open Heart Date: 2021-02
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