Risk of supranormal left ventricular ejection fraction in patients with aortic stenosis

Area of Science:

• Cardiology
• Cardiac Imaging
• Valvular Heart Disease

Background:

• Increasing cardiovascular events observed in patients with supranormal left ventricular ejection fraction (snLVEF).
• Prognostic impact of snLVEF in aortic stenosis (AS), particularly moderate AS, remains incompletely understood.

Purpose of the Study:

• To investigate the prognostic implications of snLVEF (≥50%) in patients with moderate or severe aortic stenosis.
• Evaluate associations between LVEF categories and outcomes of mortality and heart failure (HF) hospitalization.

Main Methods:

• Retrospective analysis of 226 patients with moderate or severe AS and LVEF >50%.
• Patients categorized into normal LVEF (nLVEF, 50%-65%) and supranormal LVEF (snLVEF, >65%).
• AS severity stratified by aortic valve area (moderate: 1.0-1.5 cm², severe: <1.0 cm²); primary outcomes: all-cause mortality and HF hospitalization.

Main Results:

• No significant difference in the primary composite outcome (mortality and HF hospitalization) across four groups (moderate/severe AS with nLVEF/snLVEF).
• Adjusted analysis showed a 59% lower risk of HF hospitalization for moderate AS with normal LVEF (m-nLVEF) versus moderate AS with supranormal LVEF (m-snLVEF).
• Severe AS with normal LVEF (s-nLVEF) and severe AS with supranormal LVEF (s-snLVEF) showed increased HF hospitalization risk compared to m-snLVEF.

Conclusions:

• Patients with moderate AS and supranormal LVEF face a higher risk of heart failure hospitalization compared to those with normal LVEF.
• The prognostic impact of supranormal LVEF in moderate AS warrants further investigation and clinical consideration.