Why the study?
In aortic stenosis, an EF <50% may be too conservative to indicate intervention because subendocardial fibrosis may already have developed, creating a need for an earlier marker of LV systolic dysfunction.
Does first phase ejection fraction (EF1) predict adverse clinical events better than total EF and global longitudinal strain in patients with aortic stenosis?
Does first phase ejection fraction (EF1) predict adverse clinical events better than total EF and global longitudinal strain in patients with aortic stenosis?
First phase ejection fraction (EF1) is a promising early marker of LV systolic dysfunction that may improve risk stratification and timing of surgery in asymptomatic severe aortic stenosis.
In aortic stenosis (AS), a left ventricular (LV) ejection fraction (EF) <50% or symptoms are class I indications for aortic valve intervention. However, an EF <50% may be too conservative since subendocardial fibrosis may already have developed. An earlier marker of LV systolic dysfunction is therefore needed and first phase EF (EF1) is a promising new candidate. It is the EF measured over early systole to the point of maximum transaortic blood flow. It may be low in the presence of preserved total LV EF since the heart may compensate by recruiting myosin motors in later systole. The EF1 is inversely related to the grade of AS and directly related to markers of subendocardial fibrosis like late gadolinium enhancement on cardiac magnetic resonance scanning. A reduced EF1 (<25%) predicts adverse clinical events better that total EF and global longitudinal strain. We suggest that it is worth exploring as an indication for surgery in patients with asymptomatic severe AS.
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Saeed et al. (2021) studied this question.
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