Author + information
- Received April 16, 2018
- Revision received July 10, 2018
- Accepted July 27, 2018
- Published online January 7, 2019.
- Yohann Bohbot, MDa,
- Christophe de Meester de Ravenstein, MDb,c,
- Gagandeep Chadha, MDa,
- Dan Rusinaru, MD, PhDa,d,
- Khadija Belkhir, MDa,
- Camille Trouillet, MSce,
- Agnes Pasquet, MDb,c,
- Sylvestre Marechaux, MD, PhDd,f,
- Jean-Louis Vanoverschelde, MD, PhDb,c and
- Christophe Tribouilloy, MD, PhDa,d,∗ ()
- aDepartment of Cardiology, Amiens University Hospital, Amiens, France
- bPôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- cDivision of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- dEA 7517 MP3CV Jules Verne University of Picardie, Amiens, France
- eDivision of Clinical Research and Innovation, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France
- fGroupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France, Lille, France
- ↵∗Address for correspondence:
Prof. Christophe Tribouilloy, EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France and University Hospital Amiens, France, Department of Cardiology, Avenue René Laënnec, 80054 Amiens Cedex 1, France.
Objectives This study sought to determine the best left ventricular ejection fraction (LVEF) cutoff value to predict long-term mortality in patients with asymptomatic or minimally symptomatic severe aortic stenosis (AS) and LVEF ≥50% under conservative management and after surgical correction of AS.
Background Aortic valve replacement (AVR) is a Class I indication in asymptomatic patients with severe AS and LVEF <50%. However, this is an uncommon situation in asymptomatic severe AS (<1% of patients), usually occurring late in the course of the disease. No data are available concerning the prognostic value of LVEF in asymptomatic or minimally symptomatic AS patients with preserved LVEF (≥50%) in order to identify a LVEF threshold value associated with increased mortality.
Methods This analysis included 1,678 patients with preserved LVEF and no or minimal symptoms, with a diagnosis of severe AS. The population was divided into 3 groups: LVEF <55%, LVEF 55% to 59%, and LVEF ≥60%.
Results Five-year survival rate was 72 ± 2% for patients with LVEF ≥60%, 74 ± 2% for patients with LVEF between 55% and 59%, and 59 ± 4% for patients with LVEF <55% (p < 0.001). Under initially conservative or initially surgical management (surgery within 3 months after baseline echocardiography), patients with LVEF <55% displayed significant excess mortality compared to patients with LVEF≥ 60% (adjusted hazard ratio [HR]: 2.44 [95% confidence interval: 1.51 to 3.94]; p < 0.001 and 2.51 [95% confidence interval: 1.58 to 4.00]; p < 0.001, respectively), whereas patients with LVEF between 55% and 59% had comparable prognosis to those with LVEF ≥60% (p = 0.53 and p = 0.36, respectively). In patients with LVEF <55%, initial conservative management was associated with increased mortality compared to initial surgical management, even after covariate adjustment (adjusted hazard ratio [HR]: 2.70 [95% confidence interval: 1.98 to 3.67]; p < 0.001).
Conclusions In patients with severe AS, preserved LVEF and no or minimal symptoms at the time of diagnosis, LVEF <55% is a marker of poor outcome, with medical or surgical management suggesting that these patients should be considered for surgery before this stage.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 16, 2018.
- Revision received July 10, 2018.
- Accepted July 27, 2018.
- 2019 American College of Cardiology Foundation
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