Moderate aortic stenosis: importance of symptoms and left ventricular ejection fraction
: Stassen Jan, Ewe See Hooi, Butcher Steele C, Amanullah Mohammed R, Hirasawa Kensuke, Singh Gurpreet K, Sin Kenny YK, Ding Zee P, Pio Stephan M, Sia Ching-Hui, Chew Nicholas WS, Kong William KF, Poh Kian Keong, Cohen David J, Généreux Philippe, Leon Martin B, Marsan Nina Ajmone, Delgado Victoria, Bax Jeroen J
Publisher: Oxford Academic
: 2022
: EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
: European heart journal. Cardiovascular Imaging
: Eur Heart J Cardiovasc Imaging
: jeab242
: 23
: 6
: 790
: 799
: 2047-2404
: 2047-2412
DOI: https://doi.org/10.1093/ehjci/jeab242
: https://academic.oup.com/ehjcimaging/advance-article/doi/10.1093/ehjci/jeab242/6448249?login=true
Aims
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 >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 <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 <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 < 0.001], NYHA class III-IV (HR: 2.084; 95% CI: 1.797-2.417; P < 0.001), LVEF 50-59% (HR: 1.194; 95% CI: 1.013-1.406; P = 0.034), and LVEF <50% (HR: 1.694; 95% CI: 1.417-2.026; P < 0.001) were independently associated with increased mortality.
Conclusions
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 (<60%) and mild symptoms (NYHA II) already have an increased risk of adverse events.
