Determinants of Outcome in Patients With Left Ventricular Impairment and Moderate Aortic Stenosis

Hayward, Carl; Thornton, George; Asher, Alex; Tyebally, Sara; Ray-Chaudhuri, Anirban; Mangan, Cian; Mouyis, Kyriacos; Harvey, George R.; Saheecha, Saad; Liu, Simiao; Singhal, Arvind; Karia, Nina; Patel, Ketna; Lloyd, Guy; Bhattacharyya, Sanjeev

doi:10.1016/j.jcmg.2020.01.019

Cited by 12 publications

(7 citation statements)

References 4 publications

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“…Recent studies demonstrated that moderate AS is associated with a marked incremental risk for mortality in patients with heart failure and reduced LVEF. 2,3 In addition, Hayward et al 34 showed that the major determinant of outcomes in 169 patients with moderate AS and reduced LVEF was the degree of LV systolic impairment assessed by LV GLS rather than LVEF. 34 However, even patients with moderate AS and preserved LVEF show an increased risk for adverse LV GLS as a continuous variable and in dichotomous format (according to the three groups) were separately introduced in the multivariable model.…”

Section: Prognostic Role Of LV Gls In Moderate Asmentioning

confidence: 99%

“…2,3 In addition, Hayward et al 34 showed that the major determinant of outcomes in 169 patients with moderate AS and reduced LVEF was the degree of LV systolic impairment assessed by LV GLS rather than LVEF. 34 However, even patients with moderate AS and preserved LVEF show an increased risk for adverse LV GLS as a continuous variable and in dichotomous format (according to the three groups) were separately introduced in the multivariable model. events, 7 which may be partially explained by the presence of underlying LV myocardial fibrosis.…”

Section: Prognostic Role Of LV Gls In Moderate Asmentioning

confidence: 99%

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Left Ventricular Global Longitudinal Strain in Patients with Moderate Aortic Stenosis

Stassen

Pio

Ewe

et al. 2022

Journal of the American Society of Echocardiography

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Section: Prognostic Role Of LV Gls In Moderate Asmentioning

confidence: 99%

Section: Prognostic Role Of LV Gls In Moderate Asmentioning

confidence: 99%

Left Ventricular Global Longitudinal Strain in Patients with Moderate Aortic Stenosis

Stassen

Pio

Ewe

et al. 2022

Journal of the American Society of Echocardiography

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“…While a study of a younger population of patients with moderate AS (n = 514) by Lancelotti et al [ 4 ] found a 4-year survival of 89 %, it is recognized that AS, even when not severe, can impart significant myocardial architectural changes. Increases in LV mass, mid-wall fibrosis, and extracellular volume can occur with progression of AS, even when not severe [ 18 – 22 ]. As reversibility of cardiac damage with AVR has been shown in severe AS, there is rationale for consideration of AVR in patients with moderate AS and LV dysfunction [ 23 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Natural history observations in moderate aortic stenosis

Gössl

García

et al. 2021

BMC Cardiovasc Disord

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Background The natural history of patients with moderate aortic stenosis (AS) is poorly understood. We aimed to determine the long-term outcomes of patients with moderate AS. Methods We examined patients with moderate AS defined by echocardiography in our healthcare system, and performed survival analyses for occurrence of death, heart failure (HF) hospitalization, and progression of AS, with accounting for symptoms, left ventricular dysfunction, and comorbidities. Results We examined 729 patients with moderate AS (median age, 76 years; 59.9 % men) with a median follow-up of 5.0 years (interquartile range: 2.0 to 8.1 years). The 5-year overall survival was 52.3 % (95 % confidence interval [CI]: 48.6 % to 56.0 %) and survival free of death or HF hospitalization was 43.2 % (95 % CI: 39.5 % to 46.9 %). Worse New York Heart Association (NYHA) functional class was associated with poor long-term survival, with mortality rates ranging from 7.9 % (95 % CI: 6.6–9.2 %) to 25.2 % (95 % CI: 20.2–30.3 %) per year. Among patients with minimal or no symptoms, no futility markers, and preserved left ventricular function, 5-year overall survival was 71.9 % (95 % CI: 66.4–77.4 %) and survival free of death or HF hospitalization was 61.4 % (95 % CI: 55.5–67.3 %). Risk factors associated with adverse events were age, NYHA class, low ejection fraction and high aortic valve velocity (all p < 0.05). Conclusions Patients with moderate AS are at significant risk of death. Our findings highlight the need for more study into appropriate therapeutic interventions to improve the prognosis of these patients.

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“…The identification of early markers of myocardial damage may therefore also improve the risk stratification of patients with moderate AS. Hayward and colleagues [ 18 ] showed that the degree of LV systolic dysfunction assessed by LV GLS, rather than LVEF, was the major determinant of outcome in 169 patients with moderate AS and reduced LVEF. Stassen et al demonstrated that LV GLS was independently associated with all-cause mortality in patients with moderate AS and preserved LV.…”

Section: Latest Developments In the Management Of Aortic Stenosismentioning

confidence: 99%

Focus on Diagnosis and Prognosis to Guide Timing of Intervention in Valvular Heart Disease

et al. 2022

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Purpose of Review The present article reviews the role of multimodality imaging to improve risk stratification and timing of intervention in patients with valvular heart disease (VHD), and summarizes the latest developments in transcatheter valve interventions. Recent Findings Growing evidence suggests that intervention at an earlier stage may improve outcomes of patients with significant VHD. Multimodality imaging, including strain imaging and tissue characterization with cardiac magnetic resonance imaging, has the ability to identify early markers of myocardial damage and can help to optimize the timing of intervention. Transcatheter interventions play an increasing role in the treatment of patients who remain at high surgical risk or present at a late stage of their disease. Summary Multimodality imaging identifies markers of cardiac damage at an early stage in the development of VHD. Together with technological innovations in the field of percutaneous valvular devices, these developments have the potential to improve current management and outcomes of patients with significant VHD.

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Determinants of Outcome in Patients With Left Ventricular Impairment and Moderate Aortic Stenosis

Cited by 12 publications

References 4 publications

Left Ventricular Global Longitudinal Strain in Patients with Moderate Aortic Stenosis

Left Ventricular Global Longitudinal Strain in Patients with Moderate Aortic Stenosis

Natural history observations in moderate aortic stenosis

Focus on Diagnosis and Prognosis to Guide Timing of Intervention in Valvular Heart Disease

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