Non-severe aortic stenosis was independently associated with a higher risk of all-cause death and heart failure hospitalization (HR 2.19) after cardiac resynchronization therapy.
Cohort (n=181)
No
Does non-severe aortic stenosis attenuate left ventricular reverse remodeling and worsen clinical outcomes in patients with chronic heart failure undergoing cardiac resynchronization therapy?
Concomitant non-severe aortic stenosis in patients undergoing cardiac resynchronization therapy is associated with significantly less left ventricular reverse remodeling and a more than twofold increased risk of death or heart failure hospitalization.
Hazard Ratio: 2.19 (95% CI 1.19–4.16)
p-value: p=0.01
Background: The clinical impact of non-severe aortic stenosis (AS) on the response to cardiac resynchronization therapy (CRT) remains unclear. We investigated whether non-severe AS affects left ventricular (LV) reverse remodeling and long-term outcomes after CRT. Methods and Results: We retrospectively analyzed 181 consecutive patients with chronic heart failure (mean age 70 years; 76% male) who underwent CRT at a single center. Patients were classified into a non-severe AS group (mild or moderate AS) and a no AS group. The primary endpoint was a composite of all-cause death and heart failure hospitalization. LV reverse remodeling, defined as a ≥15% reduction in LV end-systolic volume at 6 months, was evaluated as a secondary endpoint. Patients with non-severe AS were older and had a higher baseline LV ejection fraction. LV reverse remodeling occurred less frequently in the non-severe AS group (39% vs. 66%; P<0.05). Non-severe AS was independently associated with lower likelihood of LV reverse remodeling. During a median 3.5-year follow up, cumulative incidence of the composite endpoint was higher in the non-severe AS group. In multivariable Cox analysis, non-severe AS independently predicted adverse outcomes (hazard ratio 2.19; 95% confidence interval 1.19–4.16; P=0.01). Conclusions: Non-severe AS is associated with attenuated LV reverse remodeling and worse outcomes after CRT and may represent a modifier of CRT response.
Ishiyama et al. (Wed,) conducted a cohort in Chronic heart failure undergoing cardiac resynchronization therapy (n=181). Non-severe aortic stenosis (mild or moderate) vs. No aortic stenosis was evaluated on Composite of all-cause death and heart failure hospitalization (HR 2.19, 95% CI 1.19-4.16, p=0.01). Non-severe aortic stenosis was independently associated with a higher risk of all-cause death and heart failure hospitalization (HR 2.19) after cardiac resynchronization therapy.