Reduced Left Ventricular Ejection Fraction in Patients With Aortic Stenosis

Area of Science:

• Cardiology
• Cardiac Imaging
• Valvular Heart Disease

Background:

• Left ventricular ejection fraction (LVEF) reduction occurs in some patients with severe aortic stenosis (AS).
• Understanding the trajectory of LVEF decline and its prognostic implications is crucial for managing severe AS.

Purpose of the Study:

• To investigate the temporal progression of reduced LVEF in severe AS.
• To identify predictors of LVEF deterioration.
• To assess the impact of reduced LVEF on prognosis, even after aortic valve replacement.

Main Methods:

• Analysis of serial echocardiograms from 928 patients with severe AS.
• Evaluation of echocardiograms within 10 years prior to diagnosis.
• Assessment of LVEF changes relative to aortic valve area (AVA) and correlation with mortality.

Main Results:

• At diagnosis, 21% of patients had LVEF <50%.
• LVEF decline initiated before severe AS and accelerated post-AVA 1.2 cm².
• LVEF <60% at 3 years pre-AS severity was the strongest predictor of deterioration.
• Reduced LVEF (even 50-60%) was associated with significantly worse mortality post-aortic valve replacement.

Conclusions:

• Reduced LVEF in severe AS begins during the moderate AS phase and accelerates with disease progression.
• LVEF <60% in moderate AS signifies impaired cardiac function and predicts adverse outcomes.
• LVEF serves as a critical prognostic marker in patients with severe AS.