Prognostic impact of impaired left ventricular midwall function during progression of aortic stenosis
Cramariuc, Dana; Bahlmann, Edda; Egstrup, Kenneth; Rossebø, Anne B.; Ray, Simon; Kesäniemi, Yrjö Antero; Nienaber, Christoph A.; Gerdts, Eva (2020-11-04)
Cramariuc, D, Bahlmann, E, Egstrup, K, et al. Prognostic impact of impaired left ventricular midwall function during progression of aortic stenosis. Echocardiography. 2021; 38: 31– 38. https://doi.org/10.1111/echo.14916
© 2020 Wiley Periodicals LLC. This is the peer reviewed version of the following article: Cramariuc, D, Bahlmann, E, Egstrup, K, et al. Prognostic impact of impaired left ventricular midwall function during progression of aortic stenosis. Echocardiography. 2021; 38: 31– 38, which has been published in final form at https://doi.org/10.1111/echo.14916. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
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https://urn.fi/URN:NBN:fi-fe2023030129061
Tiivistelmä
Abstract
Objective: In hypertension, indexes of midwall left ventricular (LV) function may identify patients at higher cardiovascular (CV) risk independent of normal LV ejection fraction (EF). We analyzed the association of baseline and new-onset LV midwall dysfunction with CV outcome in a large population of patients with asymptomatic aortic stenosis (AS).
Methods: One thousand four hundred seventy-eight patients with asymptomatic AS and normal EF (≥50%) at baseline in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study were followed for a median of 4.3 years. LV systolic function was assessed by biplane EF and midwall shortening (MWS, low if <14% in men/16% in women) at baseline and annual echocardiographic examinations.
Results: One hundred twenty-three CV deaths and heart failure hospitalizations occurred during follow-up. In Cox analyses, adjusting for age, gender, body mass index, hypertension, EF, AS severity, LV hypertrophy and systemic arterial compliance, low baseline MWS predicted 61% higher risk of a major CV event and a twofold higher risk of death and heart failure hospitalization (P < .05). New-onset low MWS developed in 574 patients, particularly in elderly women with higher blood pressure and more severe AS (P < .05). In time-varying Cox analysis, new-onset low MWS was associated with a twofold higher risk of CV death and heart failure hospitalization, independent of changes over time in EF, AS severity, LV hypertrophy and systemic arterial compliance (P < .05).
Conclusions: Low MWS develops in a large proportion of patients with AS and normal EF during valve disease progression and is a marker of increased CV risk.
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