Related Experiment Video
Updated: Feb 16, 2026
Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents
Published on: July 14, 2021
Prognostic Impact of Left Ventricular Ejection Fraction in Patients With Severe Aortic Stenosis
Tomohiko Taniguchi1, Takeshi Morimoto2, Hiroki Shiomi1
1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Insights
Left ventricular ejection fraction (LVEF) below 60% is linked to poorer survival in severe aortic stenosis (AS) patients. Early aortic valve replacement may mitigate risks associated with reduced LVEF.
Area of Science:
- Cardiology
- Echocardiography
- Clinical Outcomes
Background:
- The prognostic significance of left ventricular ejection fraction (LVEF) in severe aortic stenosis (AS) is debated.
- Previous studies have yielded conflicting results regarding LVEF's impact on outcomes in severe AS patients.
Purpose of the Study:
- To investigate the prognostic value of LVEF in patients diagnosed with severe aortic stenosis.
- To determine if LVEF influences outcomes differently based on treatment strategy (conservative vs. early aortic valve replacement).
Main Methods:
- Analysis of 3,794 patients from the CURRENT AS registry with severe AS.
- Patients were stratified into four LVEF groups (<50%, 50-59%, 60-69%, ≥70%) and analyzed based on conservative or early aortic valve replacement strategies.
- The primary outcome was a composite of aortic valve-related death or heart failure hospitalization over 5 years.
Main Results:
- In the conservative group, LVEF <60% was associated with significantly higher 5-year mortality or heart failure hospitalization rates compared to LVEF ≥60%.
- The negative prognostic impact of reduced LVEF was significantly attenuated in patients undergoing early aortic valve replacement.
- Adjusted analyses confirmed LVEF <60% as an independent predictor of poorer outcomes in the conservative strategy group.
Conclusions:
- Survival in severe AS patients is notably impaired when LVEF falls below 60%.
- These findings underscore the importance of LVEF in guiding treatment decisions for severe AS, particularly concerning the timing of aortic valve replacement.
Objectives:
The aim of this study was to evaluate the prognostic impact of left ventricular ejection fraction (LVEF) in patients with severe aortic stenosis (AS).
Background:
The prognostic impact of LVEF in severe AS remains controversial.
Methods:
Among 3,815 consecutive patients with severe AS enrolled in the CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry, the present study population consisted of 3,794 patients after excluding 21 patients without LVEF data. Patients were divided into 4 groups according to LVEF at index echocardiography (<50%, 50% to 59%, 60% to 69%, and ≥70%; conservative strategy: n = 388, n = 390, n = 1,025, and n = 800; initial aortic valve replacement strategy: n = 206, n = 170, n = 375, and n = 440). Echocardiographic data were site reported, and there was no echocardiography core laboratory.
Results:
In the conservative group, the cumulative 5-year incidence of the primary outcome measure (a composite of aortic valve-related death or heart failure hospitalization) was significantly higher in patients with LVEFs <50% and 50% to 59% than in those with LVEFs 60% to 69% and ≥70% (72.3%, 58.4%, 38.7%, and 35.0%, respectively, p < 0.001), whereas in the initial aortic valve replacement group, the negative effect of low LVEF was markedly attenuated (20.2%, 20.3%, 17.7%, and 12.4%, respectively, p = 0.03). After adjusting for confounders, LVEF <50% (hazard ratio: 1.82; 95% confidence interval: 1.44 to 2.28; p < 0.001) and 50% to 59% (hazard ratio: 1.77; 95% confidence interval: 1.42 to 2.20; p < 0.001) but not 60% to 69% (hazard ratio: 1.14; 95% confidence interval: 0.94 to 1.39; p = 0.17) were independently associated with poorer outcomes compared with LVEF ≥70% (reference) in the conservative group. In the initial aortic valve replacement group, the adjusted risk for the primary outcome measure was not significantly different across the 4 LVEF groups.
Conclusions:
This study demonstrates that survival in patients with severe AS is impaired when LVEF is <60%, and these findings have implications for decision making with regard to the timing of surgical intervention.
More Related Videos
09:20Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
06:51Author Spotlight: Development of a Minimally Invasive Large-Animal Model for Reliable and Reproducible Cardiovascular Research
Published on: October 20, 2023
Related Concept Videos
01:19Impact of Groups on Groups
01:22Mitral Stenosis I: Introduction
01:30Impact
When particles with different initial velocities collide, they induce deformation by applying equal and opposite impulses. At the point of maximum deformation, the particles move together with...
01:32Subcellular Fractionation
Differential Centrifugation
Differential centrifugation is...
01:28Partial Fractions
01:26Mitral Stenosis III: Medical Management