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Decline in Left Ventricular Ejection Fraction During Follow-Up in Patients With Severe Aortic Stenosis

Eri Minamino-Muta1, Takao Kato1, Takeshi Morimoto2

  • 1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.

JACC. Cardiovascular Interventions
|December 21, 2019
PubMed

Insights

A significant decline in left ventricular ejection fraction (LVEF) in severe aortic stenosis (AS) patients managed conservatively predicts worse outcomes. This decline, observed at 1-year follow-up, is linked to increased AS-related deaths and heart failure hospitalizations.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Echocardiography

Background:

  • Severe aortic stenosis (AS) management is critical for patient outcomes.
  • The prognostic significance of left ventricular ejection fraction (LVEF) decline in conservatively managed severe AS patients remains under-explored.
  • Understanding LVEF changes can refine risk stratification and treatment strategies.

Purpose of the Study:

  • To assess the prognostic impact of a decline in left ventricular ejection fraction (LVEF) at 1-year follow-up.
  • To investigate the association between LVEF decline and clinical outcomes in patients with severe AS under conservative management.
  • To identify risk factors for adverse events in severe AS patients based on LVEF changes.

Main Methods:

  • Analysis of 839 patients with severe AS from the CURRENT AS registry, managed conservatively and with 1-year follow-up echocardiography.
  • Primary outcome: composite of AS-related deaths and hospitalization for heart failure.
  • Statistical analysis included survival analysis and multivariable regression to adjust for confounders.

Main Results:

  • 10.8% of patients experienced >10% decline in LVEF at 1 year.
  • LVEF decline was associated with increased left ventricular dimensions, valve regurgitation, and atrial fibrillation.
  • The 3-year cumulative incidence of the primary outcome was significantly higher in patients with LVEF decline (39.5% vs. 26.5%, p < 0.001).
  • LVEF decline remained a significant independent predictor of adverse outcomes (HR: 1.98; 95% CI: 1.29-3.06).

Conclusions:

  • A >10% decline in LVEF at 1 year in conservatively managed severe AS patients is associated with significantly worse clinical outcomes.
  • This finding holds true across different baseline LVEF subgroups.
  • Monitoring LVEF decline is crucial for risk stratification in severe AS patients not undergoing immediate intervention.
Abstract

Keywords:
conservative treatmentleft ventricular ejection fractionsevere aortic stenosis

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