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Decline in Left Ventricular Ejection Fraction During Follow-Up in Patients With Severe Aortic Stenosis |
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| Authors: | Eri Minamino-Muta Takao Kato Takeshi Morimoto Tomohiko Taniguchi Chisato Izumi Kenji Nakatsuma Moriaki Inoko Shinichi Shirai Norio Kanamori Koichiro Murata Takeshi Kitai Yuichi Kawase Makoto Miyake Hirokazu Mitsuoka Yutaka Hirano Tomoki Sasa Kazuya Nagao Tsukasa Inada Takeshi Kimura |
| Institution: | 1. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan;2. Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan;3. Division of Heart Failure, National Cerebral and Cardiovascular Center, Suita, Japan;4. Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan;5. Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan;6. Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan;7. Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan;8. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan;9. Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan;10. Department of Cardiology, Tenri Hospital, Tenri, Japan;11. Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan;12. Department of Cardiology, Kinki University Hospital, Osakasayama, Japan;13. Kishiwada City Hospital, Kishiwada, Japan;14. Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan;15. Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan;p. Department of Cardiology, Nishikobe Medical Center, Kobe, Japan;q. Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan;r. Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan;s. Department of Cardiology, Saiseikai Noe Hospital, Osaka, Japan;t. Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan;u. Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan |
| Abstract: | ObjectivesThe aim of this study was to investigate the prognostic impact of the decline in left ventricular ejection fraction (LVEF) at 1-year follow-up in patients with severe aortic stenosis (AS) managed conservatively.BackgroundNo previous study has explored the association between LVEF decline during follow-up and clinical outcomes in patients with severe AS.MethodsAmong 3,815 patients with severe AS enrolled in the multicenter CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry in Japan, 839 conservatively managed patients who underwent echocardiography at 1-year follow-up were analyzed. The primary outcome measure was a composite of AS-related deaths and hospitalization for heart failure.ResultsThere were 91 patients (10.8%) with >10% declines in LVEF and 748 patients (89.2%) without declines. Left ventricular dimensions and the prevalence of valve regurgitation and atrial fibrillation or flutter significantly increased in the group with declines in LVEF. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the group with declines in LVEF than in the group with no decline (39.5% vs. 26.5%; p < 0.001). After adjusting for confounders, the excess risk of decline in LVEF over no decline for the primary outcome measure remained significant (hazard ratio: 1.98; 95% confidence interval: 1.29 to 3.06). When stratified by LVEF at index echocardiography (≥70%, 60% to 69%, and <60%), the risk of decline in LVEF on the primary outcome was consistently seen in all the subgroups, without any interaction (p = 0.77).ConclusionsPatients with severe AS with >10% declines in LVEF at 1 year after diagnosis had worse AS-related clinical outcomes than those without declines in LVEF under conservative management. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140) |
| Keywords: | on behalf of the conservative treatment left ventricular ejection fraction severe aortic stenosis AS aortic stenosis AVA aortic valve area HF heart failure LV left ventricular LVEF left ventricular ejection fraction TAVR transcatheter aortic valve replacement Vmax peak aortic jet velocity |
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