Abstract 15050: Development of Reduced Left Ventricular Ejection Fraction and Impact on Prognosis in Severe Aortic Stenosis
Background: A subset of patients with severe aortic stenosis (AS) demonstrate left ventricular (LV) systolic dysfunction.
Objective: To describe the time course of LV ejection fraction (EF) change prior to diagnosis of severe AS, potential causes and its impact on prognosis in AS.
Methods & Results: From 2009 to 2012 from the Mayo Clinic Echocardiographic database, 1305 patients demonstrating severe AS (aortic valve area (AVA) ≤1 cm2) who had previous echocardiograms preceding this diagnosis (median 4 years) were identified. Of those, 304 (23%) patients had EF<50% (Group 1; EF 34±10 %) and 1001 (77%) had EF≥50% (Group 2; EF 64±6 %) at the time of diagnosis of severe AS. In Group 1, EF gradually declined before AS became severe and accelerated when AVA reached ≤1cm2 (Fig 1.). Coronary artery disease (CAD) was more frequent in Group 1 than Group 2 (71% vs 52%, p<0.01), but the pattern of decline in EF was similar among those with or without IHD. In multivariate model, increasing age (p=0.04, OR:1.04), male sex (p=0.02, OR:1.95), larger LV systolic dimension at -4 years (p<0.01, OR:1.15), EF at -4 years (<0.01, OR: 0.91), E/e’ at -4 years (p<0.01, OR:1.04), left bundle branch block (p<0.01, OR:3.41), bicuspid aortic valve (p=0.01, OR:0.19) and myocardial infarction (p=0.03, OR:1.99) were shown to be predictive of a drop in LVEF to <50%. Overall survival was better with AVR than without AVR for both Groups (p<0.01 for both, Fig 2.) and was worse for Group 1 compared to Group 2 (p <0.01, Fig 2.).
Conclusion: In patients with reduced EF at time of diagnosis of severe AS, EF deterioration has already begun prior to AS becoming severe and accelerates after AS reaches severe stage. Reduced EF is associated with worse prognosis even after AVR. Presence of CAD is in part responsible for reduced EF. Frequent monitoring should be considered based on patient characteristics even when AS is moderate.
Author Disclosures: S. Ito: None. V.T. Nkomo: None. S.V. Pislaru: None. K.L. Greason: None. H.M. Connolly: None. P.A. Patricia: None. J.K. Oh: None.
- © 2016 by American Heart Association, Inc.