Author + information
- Received December 22, 2017
- Revision received January 13, 2018
- Accepted January 15, 2018
- Published online March 19, 2018.
- Saki Ito, MD, MSca,
- William R. Miranda, MDa,
- Vuyisile T. Nkomo, MD, MPHa,
- Heidi M. Connolly, MDa,
- Sorin V. Pislaru, MD, PhDa,
- Kevin L. Greason, MDb,
- Patricia A. Pellikka, MDa,
- Bradley R. Lewis, MScc and
- Jae K. Oh, MDa,∗ ()
- aDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- bDepartment of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
- cDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Jae K. Oh, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
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.
Dr. Oh has served as a consultant for Medtronic CoreValve trials. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 22, 2017.
- Revision received January 13, 2018.
- Accepted January 15, 2018.
- 2018 American College of Cardiology Foundation
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