Survival in Aortic Stenosis May Be Predicted by LVEF

Aortic stenosis
Aortic stenosis
For patients with severe aortic stenosis, left ventricular ejection fraction

HealthDay News — For patients with severe aortic stenosis (AS), left ventricular ejection fraction (LVEF) below 60% is associated with impaired survival, according to a study published online in JACC: Cardiovascular Interventions.

Tomohiko Taniguchi, MD, from the Kyoto University Graduate School of Medicine in Japan, and colleagues examined the prognostic impact of LVEF in 3794 patients with severe AS. The patients were categorized into 4 groups according to LVEF at index echocardiography: <50%, 50% to 59%, 60% to 69%, and ≥70% (conservative strategy: 388, 390, 1025, and 800 patients, respectively; initial aortic valve replacement (AVR) strategy: 206, 170, 375, and 440 patients, respectively).

The researchers found that the cumulative 5-year incidence of the primary outcome measure (composite of aortic valve-related death or heart failure hospitalization) was significantly higher in patients with LVEF <50% and 50% to 59% compared with those with LVEF 60% to 69% and ≥70% in the conservative group; the negative effect of low LVEF was markedly attenuated in the initial AVR group.

Compared with LVEF ≥70%, LVEF <50% and 50% to 59%, but not 60% to 69%, were independently associated with poorer outcomes in the conservative group, after adjustment for confounders.

“Survival in severe AS is impaired when LVEF is <60%, and these findings have implications for decision-making with regards to timing of surgical intervention,” the authors wrote.

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Taniguchi T, Morimoto T, Shiomi H, et al. Prognostic impact of left ventricular ejection fraction in patients with severe aortic stenosis [published online December 18, 2017]. JACC Cardiovasc Interv. doi:10.1016/j.jcin.2017.08.036