Asymptomatic left ventricular systolic dysfunction in patients with severe aortic stenosis: Characteristics and outcomes

Danielle M. Henkel, Joseph F. Malouf, Heidi M. Connolly, Hector I Michelena, Maurice E Sarano, Hartzell V Schaff, Christopher G. Scott, Patricia Pellikka

Research output: Contribution to journalArticle

22 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)2325-2329
Number of pages5
JournalJournal of the American College of Cardiology
Volume60
Issue number22
DOIs
StatePublished - Dec 4 2012

Fingerprint

Aortic Valve Stenosis
Left Ventricular Dysfunction
Aortic Valve
Aortic Valve Insufficiency
Left Ventricular Hypertrophy
Stroke Volume
Thoracic Surgery
Coronary Artery Disease
Guidelines
Hypertension
Survival
Mortality

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 journalArticle

@article{c0465ddf8fdc43809f0f42f03025aa37,
title = "Asymptomatic left ventricular systolic dysfunction in patients with severe aortic stenosis: Characteristics and outcomes",
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.",
keywords = "aortic stenosis, echocardiography, heart failure, valve surgery, valves",
author = "Henkel, {Danielle M.} and Malouf, {Joseph F.} and Connolly, {Heidi M.} and Michelena, {Hector I} and Sarano, {Maurice E} and Schaff, {Hartzell V} and Scott, {Christopher G.} and Patricia Pellikka",
year = "2012",
month = "12",
day = "4",
doi = "10.1016/j.jacc.2012.08.988",
language = "English (US)",
volume = "60",
pages = "2325--2329",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "22",

}

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 -