Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2325-2329 |
| Number of pages | 5 |
| Journal | Journal of the American College of Cardiology |
| Volume | 60 |
| Issue number | 22 |
| DOIs | |
| State | Published - Dec 4 2012 |
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Keywords
- aortic stenosis
- echocardiography
- heart failure
- valve surgery
- valves
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Asymptomatic left ventricular systolic dysfunction in patients with severe aortic stenosis : Characteristics and outcomes. / Henkel, Danielle M.; Malouf, Joseph F.; Connolly, Heidi M.; Michelena, Hector I; Sarano, Maurice E; Schaff, Hartzell V; Scott, Christopher G.; Pellikka, Patricia.
In: Journal of the American College of Cardiology, Vol. 60, No. 22, 04.12.2012, p. 2325-2329.Research output: Contribution to journal › Article
}
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
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
UR - http://www.scopus.com/inward/record.url?scp=84870238802&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84870238802&partnerID=8YFLogxK
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 -