First-phase ejection fraction : association with remodelling and outcome in aortic valve stenosis
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
BACKGROUND: First-phase ejection fraction (EF1), the left ventricular (LV) ejection fraction (EF) until the time of peak transaortic velocity, is a novel marker of subclinical LV dysfunction able to predict adverse events in aortic stenosis (AS). This study investigated the association between end-systolic wall stress (ESWS) and EF1 in severe AS, as well as the prognostic value of EF1 in severe asymptomatic AS.
METHODS: Two prospectively gathered cohorts of 94 asymptomatic patients and 108 symptomatic patients scheduled for aortic valve replacement (AVR), all with severe AS (aortic valve area <1 cm2) were stratified according to the median value of EF1 (33%). EF1 was defined as the EF at peak transaortic velocity. Asymptomatic patients were followed up for 3 years for the combined end-point of death, AVR or admission with heart failure.
RESULTS: EF1 correlated with EF and was inversely associated with ESWS. In multivariate regression analysis, ESWS (p<0.001) and replacement fibrosis measured by MRI (p=0.02) were associated with EF1. Among asymptomatic patients, EF1 above the median was associated with the combined primary endpoint (HR=0.53 (95% CI 0.33 to 0.87)), while global longitudinal strain and EF were not. Among 42 patients with discordant AS (mean gradient <40 mm Hg), EF1 above median was associated with the primary endpoint (HR 0.28 (95% CI 0.12 to 0.61)).
CONCLUSION: EF1 is an afterload-dependent measure that is associated with events in patients with asymptomatic severe AS. The afterload dependency of EF1 may be useful in timing of risk stratification in patients with discordant AS.
TRIAL REGISTRATION NUMBERS: NCT02395107 and NCT02316587.
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
Open heart - 8(2021), 1 vom: 11. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Carter-Storch, Rasmus [VerfasserIn] |
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| Links: |
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| Themen: |
Aortic valve stenosis |
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| Anmerkungen: |
Date Completed 22.09.2021 Date Revised 22.09.2021 published: Print ClinicalTrials.gov: NCT02395107, NCT02316587 ErratumIn: Open Heart. 2021 Mar;8(1):. - PMID 33731420 Citation Status MEDLINE |
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| doi: |
10.1136/openhrt-2020-001543 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM321340299 |
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| 500 | |a Date Revised 22.09.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a ClinicalTrials.gov: NCT02395107, NCT02316587 | ||
| 500 | |a ErratumIn: Open Heart. 2021 Mar;8(1):. - PMID 33731420 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a BACKGROUND: First-phase ejection fraction (EF1), the left ventricular (LV) ejection fraction (EF) until the time of peak transaortic velocity, is a novel marker of subclinical LV dysfunction able to predict adverse events in aortic stenosis (AS). This study investigated the association between end-systolic wall stress (ESWS) and EF1 in severe AS, as well as the prognostic value of EF1 in severe asymptomatic AS | ||
| 520 | |a METHODS: Two prospectively gathered cohorts of 94 asymptomatic patients and 108 symptomatic patients scheduled for aortic valve replacement (AVR), all with severe AS (aortic valve area <1 cm2) were stratified according to the median value of EF1 (33%). EF1 was defined as the EF at peak transaortic velocity. Asymptomatic patients were followed up for 3 years for the combined end-point of death, AVR or admission with heart failure | ||
| 520 | |a RESULTS: EF1 correlated with EF and was inversely associated with ESWS. In multivariate regression analysis, ESWS (p<0.001) and replacement fibrosis measured by MRI (p=0.02) were associated with EF1. Among asymptomatic patients, EF1 above the median was associated with the combined primary endpoint (HR=0.53 (95% CI 0.33 to 0.87)), while global longitudinal strain and EF were not. Among 42 patients with discordant AS (mean gradient <40 mm Hg), EF1 above median was associated with the primary endpoint (HR 0.28 (95% CI 0.12 to 0.61)) | ||
| 520 | |a CONCLUSION: EF1 is an afterload-dependent measure that is associated with events in patients with asymptomatic severe AS. The afterload dependency of EF1 may be useful in timing of risk stratification in patients with discordant AS | ||
| 520 | |a TRIAL REGISTRATION NUMBERS: NCT02395107 and NCT02316587 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a aortic valve stenosis | |
| 650 | 4 | |a echocardiography | |
| 650 | 4 | |a magnetic resonance imaging | |
| 700 | 1 | |a Mortensen, Nils Sofus Borg |e verfasserin |4 aut | |
| 700 | 1 | |a Christensen, Nicolaj Lyhne |e verfasserin |4 aut | |
| 700 | 1 | |a Ali, Mulham |e verfasserin |4 aut | |
| 700 | 1 | |a Laursen, Kristian Bach |e verfasserin |4 aut | |
| 700 | 1 | |a Pellikka, Patricia A |e verfasserin |4 aut | |
| 700 | 1 | |a Moller, Jacob Eifer |e verfasserin |4 aut | |
| 700 | 1 | |a Dahl, Jordi S |e verfasserin |4 aut | |
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