Haotian Gu1, Sahrai Saeed2, Andrii Boguslavskyi3, Gerald Carr-White4, John B Chambers4, Phil Chowienczyk5. 1. British Heart Foundation Centre, King's College London, London, United Kingdom. 2. Haukeland University Hospital, Bergen, Norway. 3. Clinical Research Facilities, Guy's and St Thomas's Hospital, London, United Kingdom. 4. Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, United Kingdom. 5. British Heart Foundation Centre, King's College London, London, United Kingdom. Electronic address: phil.chowienczyk@kcl.ac.uk.
Abstract
OBJECTIVES: This study investigated the prognostic value of first-phase ejection fraction (EF1) in patients with aortic stenosis (AS), a condition in which left ventricular dysfunction as measured by conventional indices is an indication for valve replacement. BACKGROUND: EF1, the ejection fraction up to the time of maximal ventricular contraction may be more sensitive than existing markers in detecting early systolic dysfunction. METHODS: The predictive value of EF1 compared to that of conventional echocardiographic indices for outcomes was assessed in 218 asymptomatic patients with at least moderate AS, including 73 with moderate, 50 with severe, and 96 with "discordant" (aortic area <1.0 cm2 and gradient <40 mm Hg) AS, all with preserved EF, followed for at least 2 years. EF1 was measured retrospectively from archived echocardiographic images by wall tracking of the endocardium. The primary outcome was a combination of aortic valve intervention, hospitalization for heart failure, and death from any cause. RESULTS: EF1 was the most powerful predictor of events in the total population and all subgroups. A cutoff value of 25% (or EF1 of <25% compared to ≥25%) gave hazard ratios of 27.7 (95% confidence interval [CI]: 13.1 to 58.7; p < 0.001) unadjusted and 24.4 (95% CI: 11.3 to 52.7; p < 0.001) adjusted for other echocardiographic measurements including global longitudinal strain, for events at 2 years in all patients with asymptomatic AS. Corresponding hazard ratios for all-cause mortality in the total population were 17.5 (95% CI: 5.7 to 53.3) and 17.4 (95% CI: 5.5 to 55.2) unadjusted and adjusted, respectively. CONCLUSIONS: EF1 may be potentially valuable in the clinical management of patients with AS and other conditions in which there is progression from early to late systolic dysfunction.
OBJECTIVES: This study investigated the prognostic value of first-phase ejection fraction (EF1) in patients with aortic stenosis (AS), a condition in which left ventricular dysfunction as measured by conventional indices is an indication for valve replacement. BACKGROUND: EF1, the ejection fraction up to the time of maximal ventricular contraction may be more sensitive than existing markers in detecting early systolic dysfunction. METHODS: The predictive value of EF1 compared to that of conventional echocardiographic indices for outcomes was assessed in 218 asymptomatic patients with at least moderate AS, including 73 with moderate, 50 with severe, and 96 with "discordant" (aortic area <1.0 cm2 and gradient <40 mm Hg) AS, all with preserved EF, followed for at least 2 years. EF1 was measured retrospectively from archived echocardiographic images by wall tracking of the endocardium. The primary outcome was a combination of aortic valve intervention, hospitalization for heart failure, and death from any cause. RESULTS: EF1 was the most powerful predictor of events in the total population and all subgroups. A cutoff value of 25% (or EF1 of <25% compared to ≥25%) gave hazard ratios of 27.7 (95% confidence interval [CI]: 13.1 to 58.7; p < 0.001) unadjusted and 24.4 (95% CI: 11.3 to 52.7; p < 0.001) adjusted for other echocardiographic measurements including global longitudinal strain, for events at 2 years in all patients with asymptomatic AS. Corresponding hazard ratios for all-cause mortality in the total population were 17.5 (95% CI: 5.7 to 53.3) and 17.4 (95% CI: 5.5 to 55.2) unadjusted and adjusted, respectively. CONCLUSIONS: EF1 may be potentially valuable in the clinical management of patients with AS and other conditions in which there is progression from early to late systolic dysfunction.
Authors: Cristobal Rodero; Marina Strocchi; Maciej Marciniak; Stefano Longobardi; John Whitaker; Mark D O'Neill; Karli Gillette; Christoph Augustin; Gernot Plank; Edward J Vigmond; Pablo Lamata; Steven A Niederer Journal: PLoS Comput Biol Date: 2021-04-15 Impact factor: 4.779
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: Rong Bing; Haotian Gu; Phil Chowienczyk; Marc R Dweck; Calvin Chin; Lingyun Fang; Audrey White; Russell J Everett; Nicholas B Spath; Eunsoo Park; William Sa Jenkins; Anoop Sv Shah; Nicholas L Mills; Andrew D Flapan; John B Chambers; David E Newby Journal: Heart Date: 2020-04-28 Impact factor: 7.365
Authors: Haotian Gu; Rong Bing; Calvin Chin; Lingyun Fang; Audrey C White; Russell Everett; Nick Spath; Eunsoo Park; John B Chambers; David E Newby; Amedeo Chiribiri; Marc R Dweck; Phil Chowienczyk Journal: J Cardiovasc Magn Reson Date: 2021-06-10 Impact factor: 5.364
Authors: Kevin O'Gallagher; Ana R Cabaco; Matthew Ryan; Ali Roomi; Haotian Gu; Luke Dancy; Narbeh Melikian; Philip J Chowienczyk; Andrew J Webb; Ajay M Shah Journal: Am J Physiol Heart Circ Physiol Date: 2021-05-21 Impact factor: 4.733