Echocardiographic Markers of Early Left Ventricular Dysfunction in Asymptomatic Aortic Regurgitation: Is It Time to Change the Guidelines?

Autor:	Anand V; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: anand.vidhu@mayo.edu., Michelena HI; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Scott CG; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA., Lee AT; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA., Rigolin VH; Division of Cardiovascular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Pislaru SV; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Kane GC; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Crestanello JA; Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota, USA., Pellikka PA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2024 Oct 29. Date of Electronic Publication: 2024 Oct 29.
DOI:	10.1016/j.jcmg.2024.09.005
Abstrakt:	Background: The ideal timing for surgery in asymptomatic chronic aortic regurgitation (AR) remains unclear. New thresholds for left ventricular ejection fraction (LVEF), left ventricular (LV) indexed end-systolic volume (iESV), and global longitudinal strain (GLS) have been associated with mortality in these patients. These represent markers of early LV dysfunction. Objectives: The authors sought to assess the relationship between these markers (LVEF <60%, iESV ≥45 mL/m 2 , and GLS worse than -15%) and mortality, comparing them to Class I/IIa American College of Cardiology/American Heart Association guideline recommendations and absence of any of these. Methods: A total of 673 asymptomatic patients with chronic clinically significant (≥ moderate-severe) AR between 2004 and 2019 at a single referral center were retrospectively analyzed. The primary study outcome was all-cause mortality. Results: Mean age was 57 ± 17 years, 97 (14%) were female, 293 (45%) had hypertension, and 273 (41%) had an abnormal number of valve cusps. Aortic valve replacement was performed in 281 (48%) patients, and 69 (10%) died while under surveillance (without aortic valve replacement). LVEF <60% was present in 296 (44%) patients, 122 (25%) of 482 had GLS worse than -15%, and 261 (39%) had iESV ≥45 mL/m 2 . Mortality under surveillance was highest when Class I/IIa recommendations were present (HR: 4.22; 95% CI: 2.15-8.29), followed by the presence of 1 or more markers of early LV dysfunction (HR: 2.18; 95% CI: 1.21-3.92); no markers was used as the reference (all, P < 0.05). LVEF showed the strongest association with mortality, statistically slightly better than GLS and iESV. In the absence of Class I/IIa recommendations, 1 marker of early LV dysfunction was associated with higher, although not statistically significant, mortality compared with no markers (P = 0.063), followed by 2 markers; highest mortality was when all 3 markers were present (HR: 5.46; 95% CI: 2.51-11.90; P < 0.001). Conclusions: Patients with asymptomatic clinically significant chronic AR incur a survival penalty when Class I/IIa guideline recommendations are attained. In patients without these recommendations, at least 2 markers of early LV dysfunction identify those with higher mortality risk who may benefit from early surgery. Competing Interests: Funding Support and Author Disclosures This research was funded by a grant from the Department of Cardiovascular Medicine, Mayo Clinic. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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