Related Experiment Video
Updated: Jul 1, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Risk of supranormal left ventricular ejection fraction in patients with aortic stenosis
Naoya Inoue1,2, Hayato Ohtani3, Shuji Morikawa1,2
1Department of Cardiology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan.
Insights
Supranormal left ventricular ejection fraction (snLVEF) in moderate aortic stenosis (AS) patients increases heart failure hospitalization risk compared to normal LVEF. This finding is crucial for understanding AS prognosis.
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.
Background:
Cardiovascular events are increasing in patients with supranormal left ventricular ejection fraction (snLVEF). However, the effect of snLVEF in patients with aortic stenosis (AS) remains unclear, especially in patients with moderate AS.
Hypothesis:
This study aimed to evaluate the prognosis of mortality and heart failure (HF) in patients with LVEF ≥ 50% and moderate or severe AS.
Methods:
This retrospective study targeted patients with moderate or severe AS and LVEF > 50%. LVEF of 50%-65% was classified as normal LVEF (nLVEF, nEF group) and >65% as snLVEF (snEF group). AS severity was stratified based on the aortic valve area into moderate (1.0-1.5 cm²) and severe (<1.0 cm²). Primary outcomes included all-cause mortality and HF hospitalization.
Results:
A total of 226 participants were included in this study. There were 67 and 65 participants with moderate AS in snEF (m-snEF) and nEF groups (m-nEF), respectively, and 41 and 53 participants with severe AS in the snEF (s-snEF) and nEF groups (s-nEF), respectively. During the observation period (median: 554 days), the primary composite outcome occurred in 108 individuals. Cox hazard analysis revealed no significant differences among the four groups in primary composite outcomes. With respect to HF hospitalization, the adjusted hazard ratios (95% confidence intervals) with m-snEF as the reference were as follows: m-nEF, 0.41 (0.19-0.89); s-nEF, 1.43 (0.76-2.67); and s-snEF, 1.83 (1.00-3.35).
Conclusions:
The risk of HF hospitalization for m-snLVEF was higher than m-nLVEF and not significantly different from s-nLVEF.
More Related Videos
Related Concept Videos
01:25Cardiovascular System Abnormal Findings II: Auscultation
Abnormal Heart Sounds
Gallops:
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...