Abstract 16875: Clinical and Echocardiographic Predictors of Deterioration in Left Ventricular Ejection Fraction in Patients With Low-Flow Significant Aortic Stenosis
Background: Medically treated patients with low-flow significant aortic stenosis (AS) despite preserved left ventricular ejection fraction (LVEF) experience worse clinical outcomes. In addition, deterioration of LVEF is a Class I indication for aortic valve replacement. We aim to determine the clinical and echocardiographic predictors of LVEF deterioration.
Methods: We studied 156 consecutive subjects with low-flow (stroke volume index 180 days apart. Besides conventional echocardiography, tissue Doppler assessment of mitral annular systolic (S’), early (E’) and late (A’) diastolic velocities were performed. There were 25 patients with a significant (>20%) decrease on subsequent LVEF (Group A); we compared their baseline clinical and echocardiographic parameters to the group without deterioration (Group B).
Results: The mean age (75 vs 71 years, p=0.042) was higher in Group A; the proportion of males (64% vs 59%, p=0.664) were similar in both groups. The prevalence of hypertension (88% vs 66%, p=0.032), hyperlipidemia (60% vs 38%, p=0.046) was higher in group A, while both groups had similar prevalence of diabetes, ischemic heart disease and chronic kidney disease. Systolic and diastolic blood pressure, heart rate, serum low-density lipoprotein and creatinine levels were similar between the two groups. LVEF decreased from 56% to 31% in Group A (p<0.001) but remained similar in Group B. AS severity progressed in both groups with a fall in mean aortic valve area from 1.03 to 0.96 cm2. Higher baseline LV volumes and wall stress, as well as lower tissue Doppler S’ were predictive of LVEF deterioration (Table).
Conclusions: Despite preserved LVEF, subclinical myocardial dysfunction may represent an important comorbidity which may accelerate inappropriate left ventricular remodeling in medically treated low-flow AS patients. Close monitoring and control of factors contributing to increased wall stress may retard subsequent deterioration of LVEF.
- © 2013 by American Heart Association, Inc.