Relationship Between Left Ventricular Ejection Fraction and Mortality in Asymptomatic and Minimally Symptomatic Patients With Severe Aortic Stenosis
Key result
LVEF <55% is linked to ~144% higher mortality in asymptomatic severe aortic stenosis under conservative management.
- HR 2.44
- 95% CI 1.51 to 3.94
- P<0.001
- n=1,678
Why the study?
No data are available concerning the prognostic value of LVEF in asymptomatic or minimally symptomatic severe AS patients with preserved LVEF (≥50%) to identify a threshold associated with increased mortality.
Does an LVEF <55% predict increased mortality compared to LVEF ≥60% in asymptomatic or minimally symptomatic patients with severe aortic stenosis?
Population
1,678 patients with asymptomatic or minimally symptomatic severe AS and preserved LVEF (≥50%)
Comparison
LVEF <55% vs LVEF 55-59% vs LVEF ≥60%; initial conservative vs initial surgical management
Design
Cohort study
Authors
Discussion
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Overview
LVEF <55% flags higher mortality risk under conservative management in asymptomatic severe AS; hypothesis-generating for revised intervention thresholds pending prospective trials.
Study Design
Type
Cohort (n=1,678)
Structured PICO
Does an LVEF <55% predict increased mortality compared to LVEF ≥60% in asymptomatic or minimally symptomatic patients with severe aortic stenosis?
P
Population
1,678 patients with asymptomatic or minimally symptomatic severe aortic stenosis and preserved LVEF (≥50%) followed for up to 5 years.
E
Exposure
LVEF <55% (evaluated as a prognostic marker) and initial surgical management (surgery within 3 months after baseline echocardiography)
C
Comparator
LVEF ≥60% and LVEF 55-59%, and initial conservative management
O
Outcome
Long-term mortality (5-year survival rate)hard clinical
Main Result
Hazard Ratio: 2.44 (95% CI 1.51–3.94)
Absolute Event Rate: 59% vs 72%
p-value: p=<0.001
In asymptomatic or minimally symptomatic patients with severe aortic stenosis, an LVEF <55% is a marker of poor outcome, suggesting these patients should be considered for surgery before reaching the traditional <50% threshold.
Cite This Study
Bohbot et al. (2018) conducted a cohort in Severe aortic stenosis (n=1,678). LVEF <55% vs. LVEF ≥60% was evaluated on 5-year survival rate (HR 2.44, 95% CI 1.51 to 3.94, p=<0.001). In asymptomatic severe aortic stenosis, LVEF <55% was associated with higher mortality compared to LVEF ≥60% under conservative management (HR 2.44; 95% CI 1.51-3.94; P<0.001).