Abstract 12547: Lowest Left Ventricular Mass (LVM) Confers Survival Benefit in Patients with Severe Isolated Aortic Stenosis (AS) and Normal Left Ventricular Ejection Fraction (EF)
Objective: Left ventricular hypertrophy (LVH) in patients (pts) with severe AS is regarded as an adaptative mechanism that normalizes wall stress and myocardial oxygen demand. Recent data cast doubt on the role of LVH in maintenance of normal LV systolic function and favorable prognosis in severe AS. We hypothesized that lack of LVH might be associated with a better prognosis in such pts.
Methods: In 536 pts (mean age 78.4 ± 10.3 yrs, 51% female, 21% prospectively enrolled ) with severe isolated AS, normal EF and in sinus rhythm, we reviewed the transthoracic echocardiograms done between 2002-10. Mean follow-up: 36± 32 months. LVM was calculated by the ASE method and divided into four quartiles. Outcome variables were all-cause death and AV replacement. ANOVA, Cox proportional hazards regression and Cochran-Armitage trend tests were done with adjustment for variables including age, EF, AVA index, hypertension, heart failure, CAD and medications.
Results: (see table) Overall, 192 (35.8%) pts had no LVH (25% of women, 47% of men (p< 0.0001) LVM index (LVMi) and time to AVR were marginally related (p=0.08). Controlling for aortic valve replacement (AVR), an inverse relationship between LVMi, as a continuous variable, and time to death was found (p =0.04). Dividing LVMi into quartiles, a clear survival advantage was seen in those in lowest quartile of LVMi compared to the highest quartile (p= 0.018; HR=1.7, 95% CI 1.1, 2.5), who also had less concentric remodeling. A longer survival was not seen in those without LVH defined by ASE criteria (log-rank p=0.26).
Legend: a ANOVA model: Mean of variable, controlling for AVR, as a function of LV mass index quartile. bCochran-Armitage trend test.
Conclusions: 1. LVH is absent in 36% of patients with isolated severe AS and normal EF. 2. Higher LV mass is associated with a greater likelihood of death. 3. These data do not demonstrate a protective role for LVH by ASE definition in pts with severe AS and normal EF.
- © 2012 by American Heart Association, Inc.