Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis

Q: What are the key findings of this study?

Left ventricular diastolic dysfunction was independently associated with a 36.8% increased risk of all-cause mortality in patients with moderate aortic stenosis (HR: 1.368).

Q: What does this research mean for the field?

Left ventricular diastolic dysfunction is independently associated with a 36.8% increased risk of all-cause mortality in patients with moderate aortic stenosis. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jan Stassen; S. H. Ewe; Steele C. Butcher; MR Ammanullah; Kensuke Hirasawa; GK Singh; ZP Ding; SM Pio; Nws Chew; CH Sia; WKF Kong; Kian Keong Poh; NA Marsan; Victoria Delgado; JJ Bax

doi:10.1093/ehjci/jeab289.211

February 1, 2022European Heart Journal - Cardiovascular Imaging

Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis

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Key result

Left ventricular diastolic dysfunction is linked to ~37% higher all-cause mortality in moderate aortic stenosis.

HR: 1.368

Why the study?

Although LV diastolic dysfunction carries an unfavorable prognosis in severe aortic stenosis, its prognostic value in moderate aortic stenosis had not been investigated.

Does left ventricular diastolic dysfunction worsen prognosis (mortality and need for aortic valve replacement) in patients with moderate aortic stenosis and preserved ejection fraction?

Structured PICO

Does left ventricular diastolic dysfunction worsen prognosis (mortality and need for aortic valve replacement) in patients with moderate aortic stenosis and preserved ejection fraction?

P

Population

1,247 patients with moderate aortic stenosis (aortic valve area >1.0 and ≤1.5cm2) and preserved left ventricular ejection fraction (≥50%), mean age 74 ± 10 years, 47% men.

I

Intervention

Presence of left ventricular diastolic dysfunction (DDF) assessed by echocardiography

C

Comparator

Normal or indeterminate left ventricular diastolic function

O

Outcome

All-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR)composite

In patients with moderate aortic stenosis and preserved ejection fraction, the presence of left ventricular diastolic dysfunction is independently associated with increased all-cause mortality and the need for aortic valve replacement.

Implication

Supports diastolic assessment for prognostication in moderate aortic stenosis; extends severe aortic stenosis data but remains hypothesis-generating.

Abstract

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741 Background Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Although left ventricular (LV) diastolic dysfunction (DDF) has shown to carry an unfavorable prognosis in severe AS, the prognostic value of LV DDF in MAS has not been investigated. Purpose To investigate the prognostic impact of LV DDF in patients with MAS and preserved LV ejection fraction (EF). Methods LV diastolic function was evaluated in patients with MAS (aortic valve area >1.0 and ≤1.5cm2) and preserved LVEF (≥50%) using echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR). Results Of 1247 patients (age 74 ± 10 years, 47% men) with MAS and preserved LVEF, 396 (32%) had normal diastolic function, 316 (25%) had indeterminate diastolic function and 535 (43%) had DDF. Patients with DDF were more likely to be female, had more comorbidities (hypertension, atrial fibrillation, chronic kidney disease) and were more symptomatic (NYHA ≥2) than patients with normal diastolic function. Patients with DDF also had smaller aortic valve area and higher peak aortic velocities than patients with normal/indeterminate diastolic function. During a median follow-up of 53 (26 – 81) months, 484 (39%) patients died. For the composite endpoint, 770 patients (62%) underwent AVR (n = 376) or died (n = 394) during a median follow-up of 37 (IQR 15 – 62) months. Patients with DDF had significantly lower survival rates (p <0.001) and event-free survival rates (p = 0.015) compared to patients with normal/indeterminate diastolic function (Figure 1). On multivariable analysis, DDF was independently associated with all-cause mortality (HR: 1.368; 95% CI: 1.085 – 1.725; p = 0.008) and the composite endpoint of all-cause mortality and AVR (HR: 1.241; 95% CI: 1.035 – 1.488; p = 0.020) (Figure 2). Conclusion LV DDF is associated with worse outcomes in patients with MAS. Assessment of LV diastolic function may contribute significantly to risk stratification of patients with MAS. Abstract Figure. Abstract Figure.

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Cite This Study

Stassen et al. (2022) studied this question. Left ventricular diastolic dysfunction was independently associated with a 36.8% increased risk of all-cause mortality in patients with moderate aortic stenosis (HR: 1.368).

synapsesocial.com/papers/69696ce0fca6feb2c506acc4 https://doi.org/10.1093/ehjci/jeab289.211