Moderate Aortic Stenosis and LV Systolic Dysfunction
What are the clinical outcomes associated with moderate aortic stenosis (AS) and concomitant left ventricular (LV) systolic dysfunction?
Echocardiographic and clinical data for patients with moderate AS (aortic valve area [AVA] >1.0 and <1.5 cm2) and concomitant LV systolic dysfunction (ejection fraction [EF] <50%) were retrospectively reviewed and analyzed for four large academic institutions in the United States, Canada, and the Netherlands between 2010 and 2015. The primary endpoint was a composite of all-cause death, aortic valve replacement, and hospitalization for heart failure.
A total of 305 patients (mean age of 73 ± 11 years; 75% male) were included. The majority were symptomatic at the time of the index echocardiogram (42% New York Heart Association [NYHA] class II, 28% NYHA class III, 4% NYHA class IV). Ischemic heart disease was present in 72% of patients. At 4 years, the primary composite endpoint occurred in 61% of patients. The main predictors of the primary endpoint were male sex (p = 0.022), NYHA class III or IV (p < 0.001), and peak aortic jet velocity (p < 0.001). The rate of the composite of all-cause death or heart failure hospitalization was 48%, the rate of all-cause death was 36%, and heart failure hospitalization rate was 27%. Aortic valve replacement was performed in 24% of patients.
Patients with moderate AS and concomitant LV systolic dysfunction are at high risk for clinical events including all-cause death, hospitalization for heart failure, and aortic valve replacement. The authors concluded that further studies are needed to determine if earlier aortic valve replacement in these patients might improve clinical outcome.
LV systolic dysfunction and moderate AS commonly occur together. Although afterload-reducing therapy is the mainstay of pharmacotherapy for patients with LV systolic dysfunction, AS represents a form of mechanical LV afterload that both is not affected by, and can complicate the administration of, pharmacotherapy. Similarly, although aortic valve replacement generally is indicated only for patients with severe AS, the combination of fixed increased afterload from AS might serve to further challenge the weakened LV. Data from this retrospective, multicenter, observational study suggest that patients with combined moderate AS and LV systolic dysfunction are at high risk for all-cause death, hospitalization for heart failure, and aortic valve replacement. As the authors note, additional data are required to determine whether surgical or transcatheter intervention favorably affects outcomes among these patients.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound
Keywords: Aortic Valve Stenosis, Cardiac Imaging Techniques, Cardiac Surgical Procedures, Echocardiography, Geriatrics, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Myocardial Ischemia, Transcatheter Aortic Valve Replacement, Treatment Outcome, Ventricular Function, Left
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