A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Left ventricular remodelling patterns in patients with moderate aortic stenosis
Tekijät: Stassen Jan, Ewe See Hoi, Hirasawa Kensuke, Butcher Steele C, Singh Gurpreet K, Amanullah Mohammed R, Sin Kenny YK, Ding Zee P, Pio Stephan M, Chew Nicholas WS, Sia Ching Hui, Kong William KF, Poh Kian Keong, Cohen David J, Genereux Philippe, Leon Martin B, Marsan Nina Ajmone, Delgado Victoria, Bax Jeroen J
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
Vuosikerta: 23
Numero: 10
Aloitussivu: 1326
Lopetussivu: 1335
Sivujen määrä: 10
ISSN: 2047-2404
DOI: https://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. |