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  • 1
    Online Resource
    Online Resource
    Moderate aortic stenosis: importance of symptoms and left ventricular ejection fraction
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal - Cardiovascular Imaging Vol. 23, No. 6 ( 2022-06-01), p. 790-799
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 23, No. 6 ( 2022-06-01), p. 790-799
    Abstract: The aim of this study is to investigate the independent determinants of survival in patients with moderate aortic stenosis (AS), stratified by severity of symptoms and left ventricular ejection fraction (LVEF). Methods and results Patients with a first diagnosis of moderate AS (aortic valve area & gt;1.0 and ≤1.5 cm2) were identified. Patients were stratified by New York Heart Association (NYHA) functional class (NYHA I, NYHA II, or NYHA III–IV) and LVEF (LVEF ≥60%, LVEF 50–59%, or LVEF & lt;50%) at the time of moderate AS diagnosis. The primary endpoint was all-cause mortality, while the secondary endpoint included all-cause mortality and aortic valve replacement. Of 1961 patients with moderate AS (mean age 73 ± 10 years, 51% men), 1108 (57%) patients were in NYHA class I, while 527 (27%) and 326 (17%) patients had symptoms of NYHA class II and III–IV, respectively. Regarding LVEF, 1032 (53%) had LVEF ≥60%, 544 (28%) LVEF 50–59%, and 385 (20%) LVEF & lt;50%. During a median follow-up of 50 (23–82) months, 868 (44%) patients died. On multivariable analysis, NYHA class II [hazard ratio (HR): 1.633; 95% confidence interval (CI): 1.431–1.864; P & lt; 0.001], NYHA class III–IV (HR: 2.084; 95% CI: 1.797–2.417; P & lt; 0.001), LVEF 50–59% (HR: 1.194; 95% CI: 1.013–1.406; P = 0.034), and LVEF & lt;50% (HR: 1.694; 95% CI: 1.417–2.026; P & lt; 0.001) were independently associated with increased mortality. Conclusion Moderate AS is associated with poor long-term survival. Baseline symptom severity and LVEF are associated with worse outcomes in these patients. Patients with low-normal LVEF ( & lt;60%) and mild symptoms (NYHA II) already have an increased risk of adverse events.
    Type of Medium: Online Resource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jeab242
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2042482-6
    detail.hit.zdb_id: 2647943-6
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  • 2
    Online Resource
    Online Resource
    Left ventricular remodelling patterns in patients with moderate aortic stenosis
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal - Cardiovascular Imaging Vol. 23, No. 10 ( 2022-09-10), p. 1326-1335
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 23, No. 10 ( 2022-09-10), p. 1326-1335
    Abstract: Moderate aortic stenosis (AS) is associated with an increased risk of adverse events. Because outcomes in patients with AS are ultimately driven by the condition of the left ventricle (LV) and not by the valve, assessment of LV remodelling seems important for risk stratification. This study evaluated the association between different LV remodelling patterns and outcomes in patients with moderate AS. Methods and results  Patients with moderate AS (aortic valve area 1.0–1.5 cm2) were identified and stratified into four groups according to the LV remodelling pattern: normal geometry (NG), concentric remodelling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH). Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR). Of 1931 patients with moderate AS (age 73 ± 10 years, 52% men), 344 (18%) had NG, 469 (24%) CR, 698 (36%) CH, and 420 (22%) EH. Patients with CH and EH showed higher 3-year mortality rates (28% and 32%, respectively) when compared with patients with NG (19%) (P & lt; 0.001). After multivariable adjustment, CH remained independently associated with mortality (HR 1.258, 95% CI 1.016–1.558; P = 0.035), whereas both CH (HR 1.291, 95% CI 1.088–1.532; P = 0.003) and EH (HR 1.217, 95% CI 1.008–1.470; P = 0.042) were associated with the composite endpoint of death or AVR. Conclusion  In patients with moderate AS, those who develop CH already have an increased risk of all-cause mortality. Assessment of the LV remodelling patterns may identify patients at higher risk of adverse events, warranting closer surveillance, and possibly earlier intervention.
    Type of Medium: Online Resource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jeac018
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2042482-6
    detail.hit.zdb_id: 2647943-6
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  • 3
    Online Resource
    Online Resource
    Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis
    BMJ ; 2022
    In:  Heart Vol. 108, No. 17 ( 2022-09), p. 1401-1407
    Details
    In: Heart, BMJ, Vol. 108, No. 17 ( 2022-09), p. 1401-1407
    Abstract: To investigate the prognostic impact of left ventricular (LV) diastolic dysfunction in patients with moderate aortic stenosis (AS) and preserved LV systolic function. Methods Patients with a first diagnosis of moderate AS (aortic valve area 〉 1.0 and ≤1.5 cm 2 ) and preserved LV systolic function (LV ejection fraction ≥50%) were identified. LV diastolic function was evaluated using echocardiographic criteria according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite of all-cause mortality and aortic valve replacement (AVR). Results Of 1247 patients (age 74±10 years, 47% men), 535 (43%) had LV diastolic dysfunction at baseline. Patients with LV diastolic dysfunction showed significantly higher mortality rates at 1-year, 3-year and 5-year follow-up (13%, 30% and 41%, respectively) when compared with patients with normal LV diastolic function (6%, 17% and 29%, respectively) (p 〈 0.001). On multivariable analysis, LV diastolic dysfunction was independently associated with all-cause mortality (HR 1.368; 95% CI 1.085 to 1.725; p=0.008) and the composite endpoint of all-cause mortality and AVR (HR 1.241; 95% CI 1.035 to 1.488; p=0.020). Conclusions LV diastolic dysfunction is independently associated with all-cause mortality and the composite endpoint of all-cause mortality and AVR in patients with moderate AS and preserved LV systolic function. Assessment of LV diastolic function therefore contributes significantly to the risk stratification of patients with moderate AS. Future clinical trials are needed to investigate whether patients with moderate AS and LV diastolic dysfunction may benefit from earlier valve intervention.
    Type of Medium: Online Resource
    ISSN: 1355-6037 , 1468-201X
    URL: Article
    DOI: 10.1136/heartjnl-2022-320886
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2378689-9
    detail.hit.zdb_id: 1475501-4
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