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Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis
Jan Stassen1,2, See Hooi Ewe3, Steele C Butcher1
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Heart (British Cardiac Society)
|June 10, 2022
Summary
Left ventricular diastolic dysfunction significantly increases mortality risk in patients with moderate aortic stenosis and normal systolic function. This finding aids in risk stratification and may indicate earlier intervention benefits.
Area of Science:
- Cardiology
- Echocardiography
- Clinical Outcomes
Background:
- Moderate aortic stenosis (AS) with preserved left ventricular (LV) systolic function is common.
- The prognostic role of LV diastolic dysfunction in this patient group requires further clarification.
Purpose of the Study:
- To investigate the prognostic impact of LV diastolic dysfunction in patients with moderate AS and preserved LV systolic function.
Main Methods:
- 1247 patients with moderate AS and preserved LV ejection fraction were identified.
- LV diastolic function was assessed using 2016 ASE/EACVI guidelines.
- Outcomes included all-cause mortality and a composite of mortality and aortic valve replacement (AVR).
Main Results:
- 43% of patients (535/1247) had LV diastolic dysfunction.
- LV diastolic dysfunction was associated with significantly higher 1-, 3-, and 5-year mortality rates (p<0.001).
- LV diastolic dysfunction independently predicted all-cause mortality (HR 1.368) and the composite endpoint (HR 1.241).
Conclusions:
- LV diastolic dysfunction is an independent predictor of adverse outcomes in moderate AS with preserved LV systolic function.
- Assessing LV diastolic function is crucial for risk stratification in these patients.
- Further trials should explore earlier AVR benefits for patients with LV diastolic dysfunction.
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