Key result
LVEF decline in AS begins before severe disease, affecting ~21% of patients at diagnosis.
Why the study?
Left ventricular ejection fraction is reduced in a subset of patients with severe aortic stenosis, but its temporal course, predictors, and impact on prognosis remained to be determined.
Cohort (n=928)
In patients with severe aortic stenosis, left ventricular ejection fraction decline begins before the stenosis becomes severe and accelerates once the aortic valve area reaches 1.2 cm.
LVEF decline before severe AS diagnosis supports vigilant monitoring; hypothesis-generating for intervention timing in prospective studies.
BACKGROUND: Left ventricular ejection fraction (LVEF) is reduced in a subset of patients with severe aortic stenosis (AS). OBJECTIVES: The authors sought to determine the temporal course of reduced LVEF, its predictors, and its impact on prognosis in severe AS. METHODS: Serial echocardiograms of 928 consecutive patients with first-time diagnosis of severe AS (aortic valve area [AVA] ≤1 cm RESULTS: At the initial diagnosis, 196 (21%) patients had an LVEF <50% (35.1 ± 9.7%) and 732 (79%) had an LVEF ≥50% (64.2 ± 6.1%). LVEF deterioration had begun before AS became severe for those with an LVEF <50% and accelerated after AVA reached 1.2 cm CONCLUSIONS: In patients with severe AS and reduced LVEF, a decline in LVEF began before AS became severe and accelerated after AVA reached 1.2 cm
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Ito et al. (2018) conducted a cohort in Severe aortic stenosis (n=928). Reduced LVEF (<50%) vs. LVEF ≥50% was evaluated on LVEF deterioration. In patients with severe aortic stenosis, LVEF decline to <50% (present in 21% of patients at diagnosis) began before AS became severe and accelerated after aortic valve area reached 1.2 cm2.
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