Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis.

Autor:	Stassen J; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Cardiology, Jessa Hospital, Hasselt, Belgium., Ewe SH; Department of Cardiology, National Heart Centre Singapore, Singapore., Butcher SC; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Amanullah MR; Department of Cardiology, National Heart Centre Singapore, Singapore., Mertens BJ; Department of Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands., Hirasawa K; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Singh GK; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Sin KY; Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore., Ding ZP; Department of Cardiology, National Heart Centre Singapore, Singapore., Pio SM; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Sia CH; Department of Cardiology, National University Heart Centre, Singapore., Chew N; Department of Cardiology, National University Heart Centre, Singapore., Kong W; Department of Cardiology, National University Heart Centre, Singapore., Poh KK; Department of Cardiology, National University Heart Centre, Singapore., Cohen D; Department of Cardiology, Saint Francis Hospital The Heart Center, Roslyn, New York, USA., Généreux P; Department of Cardiology, Morristown Medical Center, Morristown, New Jersey, USA., Leon MB; Department of Cardiology, Columbia University Medical Center, New York, New York, USA., Ajmone Marsan N; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Delgado V; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Bax JJ; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands j.j.bax@lumc.nl.; Department of Cardiology, Turku Heart Center, Turku, Finland.
Jazyk:	angličtina
Zdroj:	Heart (British Cardiac Society) [Heart] 2022 Aug 11; Vol. 108 (17), pp. 1401-1407. Date of Electronic Publication: 2022 Aug 11.
DOI:	10.1136/heartjnl-2022-320886
Abstrakt:	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: Patients with a first diagnosis of moderate AS (aortic valve area >1.0 and ≤1.5 cm 2 ) 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. Competing Interests: Competing interests: The Department of Cardiology of the Leiden University Medical Centre received unrestricted research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. JJB received speaker fees from Abbott Vascular. NAM received speaker fees from Abbott Vascular and GE Healthcare. VD received speaker fees from Abbott Vascular, Edwards Lifesciences, MSD and GE Healthcare. The remaining authors have nothing to disclose. (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu