Abstract 16740: Impact of Diastolic Dysfunction on Outcomes of Patients With Aortic Stenosis
BACKGROUND: Left ventricular (LV) diastolic dysfunction (DD) is frequent in patients with aortic stenosis (AS). However, its impact on the prognosis of these patients is not well known. The objective of this study was to assess the impact of DD on mortality in a large cohort of AS patients.
METHODS: 895 consecutive patients (70±13 y.o., 58% men) with AS (52% severe) were included in this study. Diastolic function was graded into 4 classes: Normal, Grade I: abnormal relaxation, Grade II: pseudo-normal; Grade III: restrictive.
RESULTS: Among the 895 patients included in this study, 19 (2%) had normal diastolic function, 498 (56%) had Grade I, and 274 (30%) had Grade II, and 104 (12%) had Grade III. During a mean follow-up of 5.5±3.7 years, 436 patients died, including 309 from cardiovascular (CV) causes. Survival was similar among groups with no DD, Grade I, and Grade II. However, 8-year survival of patients with Grade III DD (36 ±5%) was significantly lower than that of the patients in the 3 other groups (53 ±2%; p=0.0001), resulting in a 1.7-fold increased risk of mortality in the Grade III group (HR=1.7; 95% CI: 1.3 to 2.2; p<0.001). In multivariable analysis adjusted for age, gender, body mass index, hypertension, coronary artery disease, diabetes, chronic obstructive pulmonary disease, kidney failure, peak aortic jet velocity, LV ejection fraction, LV mass index and stroke volume index, Grade III DD (HR=1.7; 95% CI: 1.3 to 2.3; p=0.001) was an independent predictor of all-cause mortality. Further adjustment for treatment (i.e. aortic valve replacement) as time dependent variable provided similar results (Grade III DD: HR=1.8; 95% CI: 1.3 to 2.4; p<0.001). Grade III DD was also associated with 1.9-fold increased risk of CV mortality (HR=1.9; 95% CI: 1.4 to 2.5; p<0.001). After similar adjustment, Grade III DD remained associated with increased CV mortality (HR=1.8; 95% CI: 1.2 to 2.5; p=0.001).
CONCLUSION: This study reports that restrictive LV filling pattern is associated with increased all-cause and cardiovascular mortality in patients with AS, even after adjustment for treatment, clinical risk factors and echocardiographic parameters. Diastolic dysfunction should be taken into consideration for the risk stratification of patients with AS.
Author Disclosures: R. Capoulade: None. A. Dahou: None. M. Clavel: None. J.G. Dumesnil: None. L. Tastet: None. M. Arsenault: None. E. Bedard: None. P. Pibarot: None.
- © 2014 by American Heart Association, Inc.