Author + information
- Received April 4, 2018
- Revision received August 23, 2018
- Accepted August 30, 2018
- Published online January 7, 2019.
- Haotian Gu, PhDa,
- Sahrai Saeed, MD, PhDb,
- Andrii Boguslavskyi, PhDc,
- Gerald Carr-White, PhDd,
- John B. Chambers, MDd,∗ and
- Phil Chowienczyk, BSca,∗∗ ()
- aBritish Heart Foundation Centre, King’s College London, London, United Kingdom
- bHaukeland University Hospital, Bergen, Norway
- cClinical Research Facilities, Guy's and St Thomas's Hospital, London, United Kingdom
- dCardiothoracic Centre, Guy's and St Thomas’ Hospital, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Phil Chowienczyk, Department of Clinical Pharmacology, St Thomas's Hospital, London SE1 7EH, United Kingdom.
Objectives This study investigated the prognostic value of first-phase ejection fraction (EF1) in patients with aortic stenosis (AS), a condition in which left ventricular dysfunction as measured by conventional indices is an indication for valve replacement.
Background EF1, the ejection fraction up to the time of maximal ventricular contraction may be more sensitive than existing markers in detecting early systolic dysfunction.
Methods The predictive value of EF1 compared to that of conventional echocardiographic indices for outcomes was assessed in 218 asymptomatic patients with at least moderate AS, including 73 with moderate, 50 with severe, and 96 with “discordant” (aortic area <1.0 cm2 and gradient <40 mm Hg) AS, all with preserved EF, followed for at least 2 years. EF1 was measured retrospectively from archived echocardiographic images by wall tracking of the endocardium. The primary outcome was a combination of aortic valve intervention, hospitalization for heart failure, and death from any cause.
Results EF1 was the most powerful predictor of events in the total population and all subgroups. A cutoff value of 25% (or EF1 of <25% compared to ≥25%) gave hazard ratios of 27.7 (95% confidence interval [CI]: 13.1 to 58.7; p < 0.001) unadjusted and 24.4 (95% CI: 11.3 to 52.7; p < 0.001) adjusted for other echocardiographic measurements including global longitudinal strain, for events at 2 years in all patients with asymptomatic AS. Corresponding hazard ratios for all-cause mortality in the total population were 17.5 (95% CI: 5.7 to 53.3) and 17.4 (95% CI: 5.5 to 55.2) unadjusted and adjusted, respectively.
Conclusions EF1 may be potentially valuable in the clinical management of patients with AS and other conditions in which there is progression from early to late systolic dysfunction.
↵∗ Drs. Chambers and Chowienczyk contributed equally to this work and are joint senior authors.
Supported by the British Heart Foundation. All authors have received support from the Department of Health through the National Institute for Health Research comprehensive Biomedical Research Centre and Clinical Research Facilities awards to Guy's and St Thomas's Hospital National Health Service (NHS) Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. Drs. Gu and Chowienczyk are named on a patent application that relates to first-phase ejection fraction. All other authors report they have no relationships relevant to the contents of this paper to disclose.
- Received April 4, 2018.
- Revision received August 23, 2018.
- Accepted August 30, 2018.
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