Reduced Left Ventricular Ejection Fraction in Patients With Aortic Stenosis

Saki Ito, William R. Miranda, Vuyisile T Nkomo, Heidi M. Connolly, Sorin V. Pislaru, Kevin L. Greason, Patricia Pellikka, Bradley R. Lewis, Jae Kuen Oh

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1313-1321
Number of pages9
JournalJournal of the American College of Cardiology
Volume71
Issue number12
DOIs
StatePublished - Mar 27 2018

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Aortic Valve Stenosis
Stroke Volume
Aortic Valve

Keywords

  • aortic stenosis
  • left ventricular systolic dysfunction
  • prognosis
  • valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Reduced Left Ventricular Ejection Fraction in Patients With Aortic Stenosis. / Ito, Saki; Miranda, William R.; Nkomo, Vuyisile T; Connolly, Heidi M.; Pislaru, Sorin V.; Greason, Kevin L.; Pellikka, Patricia; Lewis, Bradley R.; Oh, Jae Kuen.

In: Journal of the American College of Cardiology, Vol. 71, No. 12, 27.03.2018, p. 1313-1321.

Research output: Contribution to journalArticle

Ito, Saki ; Miranda, William R. ; Nkomo, Vuyisile T ; Connolly, Heidi M. ; Pislaru, Sorin V. ; Greason, Kevin L. ; Pellikka, Patricia ; Lewis, Bradley R. ; Oh, Jae Kuen. / Reduced Left Ventricular Ejection Fraction in Patients With Aortic Stenosis. In: Journal of the American College of Cardiology. 2018 ; Vol. 71, No. 12. pp. 1313-1321.
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abstract = "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.",
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T1 - Reduced Left Ventricular Ejection Fraction in Patients With Aortic Stenosis

AU - Ito, Saki

AU - Miranda, William R.

AU - Nkomo, Vuyisile T

AU - Connolly, Heidi M.

AU - Pislaru, Sorin V.

AU - Greason, Kevin L.

AU - Pellikka, Patricia

AU - Lewis, Bradley R.

AU - Oh, Jae Kuen

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N2 - 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.

AB - 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.

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KW - left ventricular systolic dysfunction

KW - prognosis

KW - valvular heart disease

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