TY - JOUR
T1 - Asymptomatic left ventricular systolic dysfunction in patients with severe aortic stenosis
T2 - Characteristics and outcomes
AU - Henkel, Danielle M.
AU - Malouf, Joseph F.
AU - Connolly, Heidi M.
AU - Michelena, Hector I.
AU - Sarano, Maurice E.
AU - Schaff, Hartzell V.
AU - Scott, Christopher G.
AU - Pellikka, Patricia A.
N1 - Funding Information:
Funding was provided by the Cardiovascular Research Division, Mayo Clinic, Rochester, Minnesota. This publication was supported by NIH/NCRR CTSA Grant Number UL1 RR024150 . Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2012/12/4
Y1 - 2012/12/4
N2 - 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 cm2, or AVA index <0.6 cm 2/m2) 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/m2) 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.
AB - 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 cm2, or AVA index <0.6 cm 2/m2) 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/m2) 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.
KW - aortic stenosis
KW - echocardiography
KW - heart failure
KW - valve surgery
KW - valves
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U2 - 10.1016/j.jacc.2012.08.988
DO - 10.1016/j.jacc.2012.08.988
M3 - Article
C2 - 23122793
AN - SCOPUS:84870238802
VL - 60
SP - 2325
EP - 2329
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 22
ER -