Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis

Heart, vol. 108, pp. 1401–1407

Abstract

OBJECTIVE: To investigate the prognostic impact of left ventricular (LV) diastolic dysfunction in patients with moderate aortic stenosis (AS) and preserved LV systolic function. METHODS: ) and preserved LV systolic function (LV ejection fraction ≥50%) were identified. LV diastolic function was evaluated using echocardiographic criteria 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 of all-cause mortality and aortic valve replacement (AVR). RESULTS: Of 1247 patients (age 74±10 years, 47% men), 535 (43%) had LV diastolic dysfunction at baseline. Patients with LV diastolic dysfunction showed significantly higher mortality rates at 1-year, 3-year and 5-year follow-up (13%, 30% and 41%, respectively) when compared with patients with normal LV diastolic function (6%, 17% and 29%, respectively) (p<0.001). On multivariable analysis, LV diastolic dysfunction was independently associated with all-cause mortality (HR 1.368; 95% CI 1.085 to 1.725; p=0.008) and the composite endpoint of all-cause mortality and AVR (HR 1.241; 95% CI 1.035 to 1.488; p=0.020). CONCLUSIONS: LV diastolic dysfunction is independently associated with all-cause mortality and the composite endpoint of all-cause mortality and AVR in patients with moderate AS and preserved LV systolic function. Assessment of LV diastolic function therefore contributes significantly to the risk stratification of patients with moderate AS. Future clinical trials are needed to investigate whether patients with moderate AS and LV diastolic dysfunction may benefit from earlier valve intervention.

Authors 20

1. Jan Stassen Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center · Jessa Hospital

   Affiliation as printed

   Department of Cardiology, Jessa Hospital, Hasselt, Belgium

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

2. See Hooi Ewe

   National Heart Centre Singapore

   Affiliation as printed

   Department of Cardiology, National Heart Centre Singapore, Singapore

3. Steele C. Butcher Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

4. Mohammed Rizwan Amanullah

   National Heart Centre Singapore

   Affiliation as printed

   Department of Cardiology, National Heart Centre Singapore, Singapore

5. Bart J.A. Mertens Aachen Department of Bioinformatics, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands

6. Kensuke Hirasawa Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

7. Gurpreet K. Singh Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

8. Kenny Yoong Kong Sin

   National Heart Centre Singapore

   Affiliation as printed

   Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore

9. Zee Pin Ding

   National Heart Centre Singapore

   Affiliation as printed

   Department of Cardiology, National Heart Centre Singapore, Singapore

10. Stephan Milhorini Pio Aachen Department of Cardiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

11. Ching‐Hui Sia

    National University Heart Centre Singapore · National Heart Centre Singapore

    Affiliation as printed

    Department of Cardiology, National University Heart Centre, Singapore

12. Nicholas Chew

    National University Heart Centre Singapore · National Heart Centre Singapore

    Affiliation as printed

    Department of Cardiology, National University Heart Centre, Singapore

13. William K F Kong

    National University Heart Centre Singapore · National Heart Centre Singapore

    Affiliation as printed

    Department of Cardiology, National University Heart Centre, Singapore

14. Kian Keong Poh

    National University Heart Centre Singapore · National Heart Centre Singapore

    Affiliation as printed

    Department of Cardiology, National University Heart Centre, Singapore

15. David J. Cohen

    St. Francis Hospital

    Affiliation as printed

    Department of Cardiology, Saint Francis Hospital The Heart Center, Roslyn, New York, USA

16. Philippe Généreux

    Morristown Medical Center

    Affiliation as printed

    Department of Cardiology, Morristown Medical Center, Morristown, New Jersey, USA

17. Martin B. Leon

    Columbia University Irving Medical Center

    Affiliation as printed

    Department of Cardiology, Columbia University Medical Center, New York, New York, USA

18. Nina Ajmone Marsan Aachen Department of Cardiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

19. Victoria Delgado Aachen Department of Cardiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

20. Jeroen Joost Bax corresponding Aachen Department of Cardiology, Leiden University Medical Center Department of Cardiology, Leiden Universitair Medisch Centrum

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

    Department of Cardiology, Turku Heart Center, Turku, Finland

    Department of Cardiology, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands