Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis

European Heart Journal - Cardiovascular Imaging, vol. 23

Abstract

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741 Background Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Although left ventricular (LV) diastolic dysfunction (DDF) has shown to carry an unfavorable prognosis in severe AS, the prognostic value of LV DDF in MAS has not been investigated. Purpose To investigate the prognostic impact of LV DDF in patients with MAS and preserved LV ejection fraction (EF). Methods LV diastolic function was evaluated in patients with MAS (aortic valve area >1.0 and ≤1.5cm2) and preserved LVEF (≥50%) using echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR). Results Of 1247 patients (age 74 ± 10 years, 47% men) with MAS and preserved LVEF, 396 (32%) had normal diastolic function, 316 (25%) had indeterminate diastolic function and 535 (43%) had DDF. Patients with DDF were more likely to be female, had more comorbidities (hypertension, atrial fibrillation, chronic kidney disease) and were more symptomatic (NYHA ≥2) than patients with normal diastolic function. Patients with DDF also had smaller aortic valve area and higher peak aortic velocities than patients with normal/indeterminate diastolic function. During a median follow-up of 53 (26 – 81) months, 484 (39%) patients died. For the composite endpoint, 770 patients (62%) underwent AVR (n = 376) or died (n = 394) during a median follow-up of 37 (IQR 15 – 62) months. Patients with DDF had significantly lower survival rates (p <0.001) and event-free survival rates (p = 0.015) compared to patients with normal/indeterminate diastolic function (Figure 1). On multivariable analysis, DDF was independently associated with all-cause mortality (HR: 1.368; 95% CI: 1.085 – 1.725; p = 0.008) and the composite endpoint of all-cause mortality and AVR (HR: 1.241; 95% CI: 1.035 – 1.488; p = 0.020) (Figure 2). Conclusion LV DDF is associated with worse outcomes in patients with MAS. Assessment of LV diastolic function may contribute significantly to risk stratification of patients with MAS. Abstract Figure. Abstract Figure.

Authors 15

1. Jan Stassen Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Leiden, Netherlands (The)

2. S. H. Ewe

   National Heart Centre Singapore

   Affiliation as printed

   National Heart Centre Singapore, Singapore, Singapore

3. Steele C. Butcher Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Leiden, Netherlands (The)

4. MR Ammanullah

   National Heart Centre Singapore

   Affiliation as printed

   National Heart Centre Singapore, Singapore, Singapore

5. Kensuke Hirasawa Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Leiden, Netherlands (The)

6. GK Singh Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Leiden, Netherlands (The)

7. ZP Ding

   National Heart Centre Singapore

   Affiliation as printed

   National Heart Centre Singapore, Singapore, Singapore

8. SM Pio Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Leiden, Netherlands (The)

9. Nws Chew

   National University Heart Centre Singapore

   Affiliation as printed

   National University Heart Centre, Singapore, Singapore

10. CH Sia

    National University Heart Centre Singapore

    Affiliation as printed

    National University Heart Centre, Singapore, Singapore

11. W K F Kong

    National University Heart Centre Singapore

    Affiliation as printed

    National University Heart Centre, Singapore, Singapore

12. Kian Keong Poh

    National University Heart Centre Singapore

    Affiliation as printed

    National University Heart Centre, Singapore, Singapore

13. NA Marsan Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center, Leiden, Netherlands (The)

14. Victoria Delgado Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center, Leiden, Netherlands (The)

15. JJ Bax Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center, Leiden, Netherlands (The)