Abstract OBJECTIVES Indications for aortic valve replacement (AVR) in severe asymptomatic aortic stenosis (AS) differ for individuals with normal vs low or decreasing left ventricular ejection fraction (LVEF). Conceptually, the development of left ventricular hypertrophy (LVH) could also indicate ventricular injury and potential need for earlier AVR. METHODS Initially, 1,232,492 echocardiography reports from 12 hospitals were identified and previously-validated, open-source natural language processing modules were then applied to identify aortic gradients, LVEF, and presence of LVH. These reports were linked to mortality data, key comorbidities, and date of any AVR. We then performed physician chart reviews, identified asymptomatic individuals with normal flow severe AS, LVEF ≥ 55% and LVH, and confirmed key clinical data manually. To assess the association between AVR and mortality, Cox proportional hazards models considering treatment status (ie, AVR or not considered as a time-dependent covariate) were used with the index echocardiogram as time zero. RESULTS After application of eligibility criteria, 607 unique, confirmed asymptomatic individuals remained for the primary analysis. After adjustment, and accounting for time-dependence of AVR, AVR was associated with reduced mortality (HR 0.37, 95% CI 0.25–0.55, p 0.0001). CONCLUSIONS AVR was associated with reduced mortality for patients with severe asymptomatic AS, preserved LVEF, and LVH. This is the largest known analysis of aortic valve replacement outcomes in individuals with severe aortic stenosis and left ventricular hypertrophy. As clinical guidelines for intervention in asymptomatic severe aortic stenosis expand, left ventricular hypertrophy is easier to assess than myocardial fibrosis and may be a useful marker for patients who need to be prioritized. These results raise the potential of more proactive AVR in individuals with LVH, even among asymptomatic individuals with normal LVEF.
Wasfy et al. (Mon,) studied this question.