Key result
Left ventricular asymmetry independently predicted the future need for aortic valve replacement in patients with asymptomatic aortic valve stenosis (HR 3.10; 95% CI 1.44-6.65; P=0.004).
Why the study?
Does left ventricular asymmetry predict future indication for aortic valve replacement in patients with asymptomatic aortic valve stenosis?
Cohort (n=114)
Does left ventricular asymmetry predict future indication for aortic valve replacement in patients with asymptomatic aortic valve stenosis?
Hazard Ratio: 3.1 (95% CI 1.44–6.65)
p-value: p=0.004
Left ventricular asymmetry assessed by computed tomography provides incremental prognostic value for predicting the future need for aortic valve replacement in asymptomatic aortic stenosis.
May refine risk stratification in asymptomatic aortic stenosis; hypothesis-generating for prospective trials on intervention timing.
Aims: Left ventricular (LV) regional hypertrophy in the form of LV asymmetry is a common finding in patients with aortic valve stenosis. The aim of this study was to test the hypothesis that LV asymmetry predicts future symptomatic status and indication for aortic valve replacement (AVR) in patients with asymptomatic aortic valve stenosis. Methods and results: In total, 114 patients with asymptomatic aortic valve stenosis (peak velocity > 2.5 m/s assessed by echocardiographic screening and LV ejection fraction > 50%) were enrolled in the study. LV asymmetry and LV geometry was assessed by multi-detector computed tomography according to previous definitions. Follow-up was conducted using electronic health records. Event-free survival was assessed using Cox proportional hazards models. Patients were followed for a median of 2.2 years (interquartile range 1.6-3.6). Indication for AVR occurred in 46 patients (40%). Patients with LV asymmetry had more than 3 times the risk of AVR (hazard ratio: 3.16; 95% CI: 1.77-5.66; P < 0.001) compared with patients with no LV asymmetry. Multivariate Cox analysis revealed that LV asymmetry was a predictor of future need of AVR (hazard ratio: 3.10; 95% CI: 1.44-6.65; P = 0.004), independent of LV geometry, jet velocity, valvular calcification, and pro-BNP. Conclusions: LV asymmetry is an independent predictor of future need for AVR in patients with asymptomatic aortic valve stenosis. It has incremental prognostic value to LV geometry and may provide a useful method of risk stratification.
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Sigvardsen et al. (2017) conducted a cohort in Asymptomatic aortic valve stenosis (n=114). Left ventricular asymmetry vs. No left ventricular asymmetry was evaluated on Indication for aortic valve replacement (AVR) (HR 3.10, 95% CI 1.44-6.65, p=0.004). Left ventricular asymmetry independently predicted the future need for aortic valve replacement in patients with asymptomatic aortic valve stenosis (HR 3.10; 95% CI 1.44-6.65; P=0.004).
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