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Left ventricular hypertrophy, diastolic dysfunction and right ventricular load predict outcome in moderate aortic
Stephan Stöbe1, Joscha Kandels1, Michael Metze1
1Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
Frontiers in Cardiovascular Medicine
|January 27, 2023
Summary
Predicting outcomes in moderate aortic valve stenosis (AS) is crucial. The presence of two or more pathophysiological changes, including left ventricular hypertrophy (LVH) and diastolic dysfunction, strongly predicts adverse events and the need for aortic valve replacement (AVR).
Area of Science:
- Cardiology
- Cardiac Physiology
- Valvular Heart Disease
Background:
- Predictors of progression in moderate aortic valve stenosis (AS) remain incompletely understood.
- Left ventricular hypertrophy (LVH), diastolic dysfunction, and right ventricular (RV) load are potential prognostic factors.
Purpose of the Study:
- To evaluate the prognostic value of LVH, diastolic dysfunction, and RV load in patients with moderate AS.
- To assess the association of these pathophysiological changes with AS progression and the need for aortic valve replacement (AVR).
Main Methods:
- A total of 131 patients with moderate AS were categorized into two groups based on the number of pathophysiological changes (LVH, diastolic dysfunction, RV load): <2 (group 1) and ≥2 (group 2).
- AS severity was defined by aortic valve area (AVA), peak transvalvular velocity (Vmax), or mean pressure gradient (PGmean).
- The primary outcome was survival without AVR, with a follow-up of 30 months.
Main Results:
- Patients with ≥2 pathophysiological changes (group 2) showed significantly more pronounced progression in AVA reduction, PGmean increase, and global longitudinal strain decrease compared to group 1.
- Survival without AVR was significantly lower in group 2 (56%) compared to group 1 (82%) [Hazard Ratio (HR) 3.94].
- Survival without AVR or AS progression was also significantly lower in group 2 (46%) versus group 1 (77%) [HR 3.80].
Conclusions:
- The presence of two or more pathophysiological changes is a strong predictor of outcome in moderate AS.
- This finding can aid in risk stratification for moderate AS patients.
- It may guide decisions regarding follow-up intervals and the optimal timing for AVR.
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