Author + information
- Received July 17, 2017
- Revision received August 24, 2017
- Accepted August 25, 2017
- Published online January 15, 2018.
- Tomohiko Taniguchi, MDa,
- Takeshi Morimoto, MD, MPHb,
- Hiroki Shiomi, MDa,
- Kenji Ando, MDc,
- Norio Kanamori, MDd,
- Koichiro Murata, MDe,
- Takeshi Kitai, MDf,
- Kazushige Kadota, MDg,
- Chisato Izumi, MDh,
- Kenji Nakatsuma, MDa,
- Tomoki Sasa, MDi,
- Hirotoshi Watanabe, MDa,
- Yasuhide Kuwabara, MDa,
- Takeru Makiyama, MDa,
- Koh Ono, MDa,
- Satoshi Shizuta, MDa,
- Takao Kato, MDa,
- Naritatsu Saito, MDa,
- Kenji Minatoya, MDj,
- Takeshi Kimura, MDa,∗ (, )
- on behalf of the CURRENT AS Registry Investigators
- aDepartment of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- bDepartment of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
- cDepartment of Cardiology, Kokura Memorial Hospital, Kokura, Japan
- dDivision of Cardiology, Shimada Municipal Hospital, Shimada, Japan
- eDepartment of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
- fDepartment of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- gDepartment of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
- hDepartment of Cardiology, Tenri Hospital, Tenri, Japan
- iDivision of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
- jDepartment of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- ↵∗Address for correspondence:
Dr. Takeshi Kimura, Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Objectives The aim of this study was to evaluate the prognostic impact of left ventricular ejection fraction (LVEF) in patients with severe aortic stenosis (AS).
Background The prognostic impact of LVEF in severe AS remains controversial.
Methods Among 3,815 consecutive patients with severe AS enrolled in the CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry, the present study population consisted of 3,794 patients after excluding 21 patients without LVEF data. Patients were divided into 4 groups according to LVEF at index echocardiography (<50%, 50% to 59%, 60% to 69%, and ≥70%; conservative strategy: n = 388, n = 390, n = 1,025, and n = 800; initial aortic valve replacement strategy: n = 206, n = 170, n = 375, and n = 440). Echocardiographic data were site reported, and there was no echocardiography core laboratory.
Results In the conservative group, the cumulative 5-year incidence of the primary outcome measure (a composite of aortic valve–related death or heart failure hospitalization) was significantly higher in patients with LVEFs <50% and 50% to 59% than in those with LVEFs 60% to 69% and ≥70% (72.3%, 58.4%, 38.7%, and 35.0%, respectively, p < 0.001), whereas in the initial aortic valve replacement group, the negative effect of low LVEF was markedly attenuated (20.2%, 20.3%, 17.7%, and 12.4%, respectively, p = 0.03). After adjusting for confounders, LVEF <50% (hazard ratio: 1.82; 95% confidence interval: 1.44 to 2.28; p < 0.001) and 50% to 59% (hazard ratio: 1.77; 95% confidence interval: 1.42 to 2.20; p < 0.001) but not 60% to 69% (hazard ratio: 1.14; 95% confidence interval: 0.94 to 1.39; p = 0.17) were independently associated with poorer outcomes compared with LVEF ≥70% (reference) in the conservative group. In the initial aortic valve replacement group, the adjusted risk for the primary outcome measure was not significantly different across the 4 LVEF groups.
Conclusions This study demonstrates that survival in patients with severe AS is impaired when LVEF is <60%, and these findings have implications for decision making with regard to the timing of surgical intervention.
This work was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 17, 2017.
- Revision received August 24, 2017.
- Accepted August 25, 2017.
- 2018 American College of Cardiology Foundation