Determinants and prognostic value of echocardiographic first-phase ejection fraction in aortic stenosis.

Autor:	Bing R; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK rong.bing@ed.ac.uk.; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK., Gu H; BHF Centre of Research Excellence, King's College London, London, UK., Chin C; Cardiovascular Medicine, National Heart Center Singapore, Singapore., Fang L; BHF Centre of Research Excellence, King's College London, London, UK., White A; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK., Everett RJ; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK., Spath NB; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK., Park E; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK., Jenkins WS; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK., Shah AS; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK., Mills NL; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK., Flapan AD; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK., Chambers JB; Guy's and Saint Thomas' Hospitals NHS Trust, London, UK., Newby DE; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK., Chowienczyk P; BHF Centre of Research Excellence, King's College London, London, UK.; Guy's and Saint Thomas' Hospitals NHS Trust, London, UK., Dweck MR; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.; BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK.
Jazyk:	angličtina
Zdroj:	Heart (British Cardiac Society) [Heart] 2020 Aug; Vol. 106 (16), pp. 1236-1243. Date of Electronic Publication: 2020 Apr 28.
DOI:	10.1136/heartjnl-2020-316684
Abstrakt:	Objective: First-phase ejection fraction (EF1) is a novel measure of early left ventricular systolic dysfunction. We investigated determinants of EF1 and its prognostic value in aortic stenosis. Methods: EF1 was measured retrospectively in participants of an echocardiography/cardiovascular magnetic resonance cohort study which recruited patients with aortic stenosis (peak aortic velocity of ≥2 m/s) between 2012 and 2014. Linear regression models were constructed to examine variables associated with EF1. Cox proportional hazards were used to determine the prognostic power of EF1 for aortic valve replacement (AVR, performed as part of clinical care in accordance with international guidelines) or death. Results: Total follow-up of the 149 participants (69.8% male, 70 (65-76) years, mean gradient 33 (21-42) mm Hg) was 238 029 person-days. Sixty-seven participants (45%) had a low baseline EF1 (<25%) despite normal ejection fraction (67% (62%-71%)). Patients with low EF1 had more severe aortic stenosis (mean gradient 39 (34-45) mm Hg vs 24 (16-35) mm Hg, p<0.001) and more myocardial fibrosis (indexed extracellular volume (iECV) (24.2 (19.6-28.7) mL/m 2 vs 20.6 (16.8-24.3) mL/m 2 , p=0.002; late gadolinium enhancement (LGE) prevalence 52% vs 20%, p<0.001). Zva, iECV and infarct LGE were independent predictors of EF1. EF1 improved post-AVR (n=57 with post-AVR EF1 available, baseline 16 (12-24) vs follow-up 27% (22%-31%); p<0.001). Low baseline EF1 was an independent predictor of AVR/death (HR 5.6, 95% CI 3.4 to 9.4), driven by AVR. Conclusion: EF1 quantifies early, potentially reversible systolic dysfunction in aortic stenosis, is associated with global afterload and myocardial fibrosis, and is an independent predictor of AVR. Competing Interests: Competing interests: HG and PC are named on a patent for the use of first-phase ejection fraction (WO2017144851A1). (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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