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Impact of Left Ventricular Ejection Fraction on Clinical Outcomes in Bicuspid Aortic Valve Disease

Sébastien Hecht1, Steele C Butcher2, Stephan M Pio3

  • 1Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.

Journal of the American College of Cardiology
|September 8, 2022
PubMed

Insights

Left ventricular ejection fraction (LVEF) impacts outcomes in bicuspid aortic valve (BAV) disease. Lower LVEF (<60%) significantly increases mortality and adverse events in BAV patients, suggesting revised intervention thresholds.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Outcomes Research

Background:

  • Prognostic impact of left ventricular ejection fraction (LVEF) in bicuspid aortic valve (BAV) disease remains understudied.
  • BAV is a common congenital heart defect associated with various aortic pathologies.

Purpose of the Study:

  • To investigate the prognostic significance of LVEF in patients with BAV.
  • To analyze LVEF impact based on the type of aortic valve dysfunction (AS, AR, MAVD).

Main Methods:

  • Retrospective analysis of 2,672 patients from an international BAV registry.
  • Classification of patients by aortic valve dysfunction: isolated AS, isolated AR, mixed aortic valve disease (MAVD).
  • Stratification of patients by LVEF to assess clinical outcomes.

Main Results:

  • Reduced LVEF (<60%) correlated with increased all-cause mortality and composite endpoints (AVR/repair + mortality) in the overall BAV cohort.
  • This association was observed in isolated AS and AR groups (<60% LVEF) and MAVD group (<55% LVEF).
  • Multivariable analysis confirmed LVEF strata (50-59%, 30-49%, <30%) as significant predictors of mortality.

Conclusions:

  • Lower LVEF (<60%) is a significant risk factor for adverse clinical outcomes in BAV patients.
  • Current guideline LVEF cutoffs for intervention may need upward revision to 60% for AS/AR and 55% for MAVD.
  • LVEF is a crucial prognostic marker in BAV disease management.
Abstract

Keywords:
aortic regurgitationaortic stenosisbicuspid aortic valveleft ventricular ejection fractionmixed aortic valve disease

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