Key result
In asymptomatic aortic stenosis patients, myocardial external efficiency increased over 2.8 years and higher baseline MEE predicted worse 5.2-year cardiac outcomes.
Why the study?
In patients with aortic valve stenosis, the pathophysiological abnormalities involved in the transition to heart failure and whether changes in myocardial external efficiency are involved in disease progression were unknown.
Does myocardial external efficiency (MEE) change over time and predict long-term cardiac events in asymptomatic patients with moderate-severe aortic valve stenosis?
Does myocardial external efficiency (MEE) change over time and predict long-term cardiac events in asymptomatic patients with moderate-severe aortic valve stenosis?
In asymptomatic patients with moderate-severe aortic stenosis, myocardial external efficiency increases over time in response to pressure overload, and a higher baseline efficiency is predictive of future cardiac events.
Higher baseline MEE was associated with events in asymptomatic AS; leaves open whether efficiency monitoring should guide intervention timing.
Background In patients with aortic valve stenosis (AS), the pathophysiological abnormalities involved in the transition to heart failure are unclear. As chronic heart failure progresses, the ratio between myocardial stroke work and oxygen consumption, i.e. myocardial external efficiency (MEE), steadily deteriorates. However, in patients with AS, it is unknown whether changes in MEE are involved in disease progression. Purpose We investigated changes in MEE and if MEE was associated with long-term prognosis in patients with AS. Methods Ten healthy controls and 38 patients with moderate-severe AS and preserved left ventricular ejection fraction ≥50% were included in the study. To evaluate MEE, we used serial 11C-acetate positron emission tomography, cardiovascular magnetic resonance imaging and echocardiography, with a median follow-up period of 2.8 years. Furthermore, we conducted a long-term follow-up for a median of 5.2 years to detect cardiac events and related them to MEE. Results In patients with AS, MEE increased during follow-up from 25.2% (95% CI: 24.0 to 26.5%) to 29.5% (95% CI: 27.3 to 31.8%; p=0.001) and was higher than in healthy volunteers, 19.9% (18.1 to 21.8; p<0.001). Patients who experienced a cardiac event during long-term follow-up (n=24, 63%) had higher baseline MEE, 26.5% (95% CI: 24.6 to 28.4%), than event-free patients, 23.3% (95% CI: 22.2 to 24.3%; p=0.004). Conclusion In asymptomatic patients with AS, MEE increased over time and high baseline MEE predicted a poor prognosis. Thus, the myocardium displayed an inherent capacity to improve the coupling between oxidative metabolism and contractile function in response to pressure overload.
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Hansson et al. (2026) studied this question. In asymptomatic aortic stenosis patients, myocardial external efficiency increased over 2.8 years and higher baseline MEE predicted worse 5.2-year cardiac outcomes.
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