Key result
Lower noninvasive LV stiffness at rest and exercise predicts better cardiac outcomes in asymptomatic severe AS.
Why the study?
Noninvasively estimated LV stiffness had not been systematically evaluated in aortic stenosis.
Does noninvasive LV stiffness at rest and during exercise predict cardiac events in asymptomatic severe aortic stenosis?
Cohort (n=48)
No
Does noninvasive LV stiffness at rest and during exercise predict cardiac events in asymptomatic severe aortic stenosis?
Effect estimate: AUC 0.67 (rest) / 0.68 (exercise)
p-value: p=0.036 / 0.054
Noninvasive assessment of left ventricular stiffness at rest and during exercise provides prognostic value for predicting cardiac events in patients with asymptomatic severe aortic stenosis.
May support noninvasive LV stiffness for prognostication in asymptomatic severe AS; leaves open whether it should guide management.
Introduction Left ventricular (LV) stiffness can be estimated noninvasively with echocardiography, but has not been systematically evaluated in aortic stenosis (AS). Purpose Purpose was to assess noninvasively the LV stiffness in asymptomatic severe AS, both at rest (R) and during supine ergometry (Ex), and to interrogate potential relationships with the cardiac outcome. Methods Forty eight AS patients (pts), followed up on valve clinic in a tertiary center (age 66±12), were referred for Ex. Severe AS was defined as aortic valve area <1cm2. AS related cardiac events (independent decision for surgery, NYHA worsening) during a follow up of 33±21 months occurred in 19 pts. The following parameters were estimated noninvasively both at rest-R/Ex: LV enddiastolic volume (LVEDvol/ml), stroke volume index (SVi ml/m2) ejection fraction (EF:%), strain (SR:%), transmitral E/e ratio, peak transtricuspid systolic pressure (TRPG: mmHg), AV mean gradient (meanGR: mmHg), valvuloarterial impedance (Za: mm Hg·ml-1m2), and LV stiffness as the ratio E/e/LVEDvol (mL-1). Results LV stiffness was lower (implying a greater compliance) both at R and Ex in pts with normal flow (>35mL/min/m2) low gradient (NFLG,n=8) compared to low flow low gradient pts (LFLG, n=18) and normal flow/ high gradient (NFHG, n=22): R NFLG: 0.16±0.11 vs LFLG: 0.28±0.14 (p=0.014) and NFHG: 0.21/0.1 (p=0.04), Ex NFLG: 0.10±0.04 vs LFLG: 0.18±0.06 (p=0.04) and NFHG 0.22±0.12 (p=0.05) respectively. SVi was inversely related to LV stiffness at R/Ex (R2=0.23 /0.43, p<0.001). Za was also related to LV stiffness at R/Ex (R2=0.27 /0.32, p=0.003/0.004 figure1). ROC analysis for outcome provided similar cut off (0.14) for LV stiffness both at R/Ex: area under curve 0.67/0.68, p=0.036/0.054, sensitivity=0.51/0.53 specificity=0.82/0.84 respectively (figure 2). Conclusion In asymptomatic AS, noninvasive LV stiffness both at R and Ex is an important parameter for the understanding of the underlying complexities of the pathophysiology, providing specific prognostic yield.
No takes yet. Share an insight, caveat, or question.
Armenis et al. (2026) conducted a cohort in Asymptomatic severe aortic stenosis (n=48). Noninvasive left ventricular stiffness was evaluated on AS related cardiac events (independent decision for surgery, NYHA worsening) (AUC 0.67 (rest) / 0.68 (exercise), p=0.036 / 0.054). Noninvasive left ventricular stiffness at rest and during exercise predicted cardiac events in asymptomatic severe aortic stenosis, with an optimal cutoff of 0.14 (AUC 0.67 at rest, p=0.036).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: