Key result
Global myocardial work index ≤ 1951 mmHg% fails to predict AVR need in moderate aortic stenosis.
Why the study?
Reduced global myocardial work index is linked to increased mortality in severe aortic valve stenosis, but prognostic parameters in moderate aortic valve stenosis remain limited.
Does a reduced global myocardial work index (≤ 1951 mmHg%) predict the need for aortic valve replacement in patients with moderate aortic valve stenosis?
Cohort (n=103)
Does a reduced global myocardial work index (≤ 1951 mmHg%) predict the need for aortic valve replacement in patients with moderate aortic valve stenosis?
Effect estimate: HR 1.31 (95% CI 0.63-2.72)
Absolute Event Rate: 68% vs 80%
p-value: p=0.49
In patients with moderate aortic valve stenosis, a reduced global myocardial work index (≤ 1951 mmHg%) does not predict the need for aortic valve replacement, unlike in severe AS.
Does not support myocardial work index for aortic valve replacement prediction in moderate stenosis; hypothesis-generating and requires prospective validation.
Background: A reduced global myocardial work index (GWI) ≤ 1951 mmHg% is associated with increased mortality in patients with severe aortic valve stenosis (AS). However, parameters predicting the outcome in patients with moderate AS are limited. Therefore, the aim of this study was to evaluate the prognostic value of the GWI in patients with moderate AS. Methods and Results: In this prospective study, 103 patients with moderate AS (mean age 72 ± 10 years; male: 69%) underwent standardized transthoracic echocardiography. The primary endpoint was survival without an aortic valve replacement (AVR). After a median follow-up of 30 ± 5 months, 37 patients (36%) were referred for an AVR. Survival without an AVR was 96% at 12 months and 80% at 30 months (>1951 mmHg%) versus 96% and 68% (≤1951 mmHg%). A GWI ≤ 1951 mmHg% did not predict the need for an AVR (hazard ratio 1.31 (95% CI, 0.63–2.72), p = 0.49). Furthermore, there was no significant correlation between the mean GWI (1644 ± 448 mmHg%) and mean aortic valve pressure gradient (24.2 mmHg ± 6.2, p = 0.615) or effective aortic orifice area (1.24 cm2 ± 0.11, p = 0.678). There was no difference between the AVR and non-AVR groups in the occurrence of clinical symptoms. Conclusion: In contrast to patients with severe AS, a GWI ≤ 1951 mmHg% did not predict the need for an AVR. Further research is needed to improve the risk stratification in patients with moderate AS.
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Kandels et al. (2023) conducted a cohort in moderate aortic valve stenosis (n=103). Global myocardial work index (GWI) ≤ 1951 mmHg% vs. GWI > 1951 mmHg% was evaluated on survival without an aortic valve replacement (AVR) (HR 1.31, 95% CI 0.63-2.72, p=0.49). A global myocardial work index ≤ 1951 mmHg% did not predict the need for an aortic valve replacement in patients with moderate aortic valve stenosis (HR 1.31; 95% CI 0.63-2.72; p=0.49).
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