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Prognostic impact of impaired left ventricular midwall function during progression of aortic stenosis

Dana Cramariuc1, Edda Bahlmann2, Kenneth Egstrup3

  • 1Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

Echocardiography (Mount Kisco, N.Y.)
|November 4, 2020
PubMed

Insights

Midwall systolic dysfunction, a measure of left ventricular function, identifies increased cardiovascular risk in patients with asymptomatic aortic stenosis, even with normal ejection fraction. This dysfunction predicts a twofold higher risk of death and heart failure hospitalization.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiovascular Risk Assessment

Background:

  • Midwall left ventricular (LV) function indexes may identify cardiovascular (CV) risk in hypertension, independent of ejection fraction (EF).
  • Asymptomatic aortic stenosis (AS) patients with normal EF can have varying CV outcomes.
  • Assessing LV midwall function offers a potential risk stratification tool.

Purpose of the Study:

  • To analyze the association of baseline and new-onset LV midwall dysfunction with CV outcomes in asymptomatic aortic stenosis (AS) patients.
  • To determine if midwall shortening (MWS) predicts major adverse CV events in this population.
  • To investigate the prevalence and predictors of new-onset LV midwall dysfunction during AS progression.

Main Methods:

  • Analysis of 1,478 patients with asymptomatic AS and normal EF from the SEAS study.
  • Assessment of LV systolic function using biplane EF and midwall shortening (MWS) via echocardiography.
  • Cox proportional hazards models used to assess the association of MWS with CV outcomes, adjusting for multiple covariates.

Main Results:

  • Low baseline MWS predicted a 61% higher risk of major CV events and a twofold higher risk of CV death/heart failure hospitalization (P < .05).
  • New-onset low MWS developed in 574 patients, associated with older age, female gender, higher blood pressure, and more severe AS.
  • New-onset low MWS independently predicted a twofold higher risk of CV death and heart failure hospitalization (P < .05).

Conclusions:

  • Low midwall shortening (MWS) develops in a significant proportion of asymptomatic aortic stenosis (AS) patients with normal ejection fraction (EF) as valve disease progresses.
  • LV midwall dysfunction serves as an independent marker of increased cardiovascular risk in this patient cohort.
  • These findings highlight the importance of assessing midwall function for risk stratification in AS.
Abstract

Keywords:
aortic stenosisechocardiographymidwall functionprognosis

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