Evaluation of Left Ventricular Function for Risk Stratification in Asymptomatic Severe Aortic Stenosis With Preserved Contractility

BACKGROUND: The objective of this study was to evaluate the prognostic value of echocardiographic evidence of left ventricular remodeling for timing of aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis. METHODS: A single-institutional retrospective study including asymptomatic patients with severe aortic stenosis and preserved ejection fraction treated from 2016-2024 was performed. Patients were stratified into asymptomatic and conservative AVR groups who underwent AVR prior to and after the development of symptoms, respectively. The primary outcome was a composite endpoint of mortality, myocardial infarction, stroke, and heart failure readmission. The incidence of the primary outcome was compared between groups, and the association of echocardiographic parameters with the incidence of the primary outcome was evaluated. RESULTS: Of 160 patients, 65 (41%) were in the asymptomatic and 95 (59%) were in the conservative AVR group with a median age of 72 (interquartile range, 65-78) years. Incidence of the primary outcome was lower in asymptomatic compared with conservative AVR groups (adjusted hazard ratio aHR, 0.27; 95% CI, 0.12-0.63; P = .002). Higher E/é (aHR, 1.39; 95% CI, 1.10-1.75; P = .006), indexed left ventricular (LV) end-diastolic volume (aHR, 1.22; 95% CI, 1.00-1.47; P = .04), and indexed LV end-systolic volume (aHR, 1.71; 95% CI, 1.00-2.93; P = .05) were associated with a higher incidence of the primary outcome. CONCLUSIONS: AVR in asymptomatic patients with severe aortic stenosis improved outcomes with specific echocardiographic parameters as risk factors including higher E/é, indexed LV end-diastolic volume, and indexed LV end-systolic volume. Although additional studies are needed, these findings may assist in patient selection and timing of AVR.