Vertaisarvioitu alkuperäisartikkeli tai data-artikkeli tieteellisessä aikakauslehdessä (A1)
Left ventricular remodelling patterns in patients with moderate aortic stenosis
Julkaisun tekijät: Stassen J, Ewe SH, Hirasawa K, Butcher SC, Singh GK, Amanullah MR, Sin KYK, Ding ZP, Pio SM, Chew NWS, Sia CH, Kong WKF, Poh KK, Cohen DJ, Genereux P, Leon MB, Marsan NA, Delgado V, Bax JJ
Kustantaja: OXFORD UNIV PRESS
Julkaisuvuosi: 2022
Journal: EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
Tietokannassa oleva lehden nimi: EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
Lehden akronyymi: EUR HEART J-CARD IMG
Sivujen määrä: 10
ISSN: 2047-2404
DOI: http://dx.doi.org/10.1093/ehjci/jeac018
Verkko-osoite: https://doi.org/10.1093/ehjci/jeac018
Rinnakkaistallenteen osoite: https://research.utu.fi/converis/portal/detail/Publication/174878682
Aims: 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 < 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.
Ladattava julkaisu This is an electronic reprint of the original article. |