Prognostic Impact of Left Ventricular Ejection Fraction in Patients With Severe Aortic Stenosis
Table 1
Baseline Clinical and Echocardiographic Characteristics According to the Baseline Left Ventricular Ejection Fraction Categories in the Entire Cohort
LVEF <50% (n = 594) | LVEF 50%–59% (n = 560) | LVEF 60%–69% (n = 1,400) | LVEF ≥70% (n = 1,240) | p Value | |
---|---|---|---|---|---|
Clinical characteristics | |||||
Age, yrs∗ | 78.4 ± 9.4 | 78.7 ± 10.0 | 78.0 ± 9.7 | 76.7 ± 9.8 | <0.001 |
Age ≥80 yrs | 283 (48) | 279 (50) | 638 (46) | 514 (41) | 0.004 |
Male∗ | 303 (51) | 243 (43) | 522 (37) | 370 (30) | <0.001 |
BMI, kg/m2 | 21.1 ± 3.8 | 21.5 ± 3.8 | 21.9 ± 3.9 | 22.1 ± 3.7 | <0.001 |
BMI <22 kg/m2∗ | 399 (67) | 355 (63) | 835 (60) | 722 (58) | 0.001 |
BSA, m2 | 1.47 ± 0.18 | 1.45 ± 0.19 | 1.46 ± 0.19 | 1.46 ± 0.18 | 0.58 |
Hypertension∗ | 421 (71) | 379 (68) | 1,009 (72) | 847 (68) | 0.10 |
Current smoking∗ | 34 (6) | 27 (5) | 76 (5) | 58 (5) | 0.73 |
History of smoking | 159 (27) | 135 (24) | 305 (22) | 228 (18) | <0.001 |
Dyslipidemia | 191 (32) | 164 (29) | 469 (34) | 498 (40) | <0.001 |
On statin therapy | 137 (23) | 108 (19) | 345 (25) | 377 (30) | <0.001 |
Diabetes mellitus | 176 (30) | 130 (23) | 333 (24) | 256 (21) | <0.001 |
On insulin therapy∗ | 37 (6) | 32 (6) | 66 (5) | 53 (4) | 0.25 |
Prior myocardial infarction∗ | 140 (24) | 63 (11) | 74 (5) | 42 (3) | <0.001 |
Coronary artery disease∗ | 290 (49) | 189 (34) | 361 (26) | 295 (24) | <0.001 |
Prior PCI | 137 (23) | 81 (14) | 168 (12) | 115 (9) | <0.001 |
Prior CABG | 67 (11) | 40 (7) | 50 (4) | 40 (3) | <0.001 |
Prior open heart surgery | 83 (14) | 61 (11) | 101 (7) | 69 (6) | <0.001 |
Prior symptomatic stroke∗ | 87 (15) | 73 (13) | 228 (16) | 112 (9) | <0.001 |
Atrial fibrillation or flutter∗ | 146 (25) | 158 (28) | 307 (22) | 212 (17) | <0.001 |
Aortic/peripheral vascular disease∗ | 65 (11) | 46 (8) | 105 (8) | 65 (5) | <0.001 |
Serum creatinine, mg/dl∗ | 1.1 (0.8–2.1) | 1.0 (0.7–1.5) | 0.9 (0.7–1.2) | 0.8 (0.7–1.0) | <0.001 |
Creatinine >2 mg/dl | 151 (25) | 108 (19) | 198 (14) | 100 (8) | <0.001 |
Hemodialysis∗ | 105 (18) | 83 (15) | 149 (11) | 67 (5) | <0.001 |
Anemia∗† | 380 (64) | 341 (61) | 775 (55) | 611 (49) | <0.001 |
Liver cirrhosis (Child-Pugh B/C)∗ | 6 (1) | 2 (0.4) | 19 (1) | 10 (1) | 0.19 |
Malignancy | 85 (14) | 69 (12) | 192 (14) | 170 (14) | 0.79 |
Malignancy currently under treatment∗ | 21 (4) | 17 (3) | 63 (5) | 48 (4) | 0.45 |
Chest wall irradiation | 6 (1) | 3 (1) | 9 (1) | 7 (1) | 0.70 |
Immunosuppressive therapy | 24 (4) | 18 (3) | 38 (3) | 50 (4) | 0.23 |
Chronic lung disease | 64 (11) | 67 (12) | 137 (10) | 130 (10) | 0.55 |
Chronic lung disease (moderate or severe)∗ | 23 (4) | 18 (3) | 37 (3) | 33 (3) | 0.43 |
Logistic EuroSCORE, % | 19.3 (10.9–31.7) | 10.9 (6.2–18.0) | 9.0 (5.5–14.4) | 7.9 (4.9–12.8) | <0.001 |
EuroSCORE II, % | 5.7 (3.4–10.3) | 3.1 (1.8–5.6) | 2.7 (1.6–4.1) | 2.4 (1.3–3.7) | <0.001 |
STS PROM score, % | 5.8 (3.3–10.4) | 4.6 (2.6–7.9) | 3.7 (2.2–6.0) | 3.0 (2.0–4.9) | <0.001 |
Symptom related to AS | 452 (76) | 347 (62) | 628 (45) | 562 (45) | <0.001 |
Chest pain | 70 | 71 | 146 | 204 | |
Syncope | 22 | 38 | 80 | 56 | |
Heart failure | 431 | 300 | 477 | 384 | |
HF hospitalization at index echocardiography∗ | 280 (47) | 168 (30) | 195 (14) | 141 (11) | <0.001 |
Etiology of aortic stenosis | |||||
Degenerative | 549 (92) | 503 (90) | 1,251 (89) | 1,057 (85) | 0.001 |
Congenital (unicuspid, bicuspid, or quadricuspid) | 30 (5) | 34 (6) | 79 (6) | 114 (9) | |
Rheumatic | 9 (2) | 20 (4) | 61 (4) | 59 (5) | |
Infective endocarditis | 1 (0.2) | 2 (0.4) | 2 (0.1) | 2 (0.2) | |
Other | 5 (1) | 1 (0.2) | 7 (0.5) | 8 (0.7) | |
Echocardiographic variables | |||||
Vmax, m/s | 3.78 ± 0.99 | 4.13 ± 0.96 | 4.11 ± 0.87 | 4.33 ± 0.86 | <0.001 |
Vmax ≥5 m/s | 81 (14) | 99 (18) | 245 (18) | 268 (22) | <0.001 |
Vmax ≥4 m/s∗ | 255 (43) | 316 (56) | 769 (55) | 829 (67) | <0.001 |
Peak aortic PG, mm Hg | 61 ± 31 | 72 ± 34 | 71 ± 30 | 78 ± 31 | <0.001 |
Mean aortic PG, mm Hg | 35 ± 19 | 40 ± 20 | 40 ± 19 | 45 ± 20 | <0.001 |
AVA (continuity equation), cm2 | 0.68 ± 0.20 | 0.70 ± 0.19 | 0.73 ± 0.17 | 0.74 ± 0.18 | <0.001 |
Indexed AVA, cm2/m2 | 0.47 ± 0.14 | 0.49 ± 0.13 | 0.51 ± 0.13 | 0.51 ± 0.12 | <0.001 |
LV end-diastolic diameter, mm | 52.7 ± 7.8 | 46.9 ± 6.6 | 44.5 ± 5.8 | 43.9 ± 5.9 | <0.001 |
LV end-systolic diameter, mm | 42.3 ± 8.2 | 33.0 ± 5.7 | 28.6 ± 4.5 | 25.1 ± 4.4 | <0.001 |
LVEF, % | 38.1 ± 8.6 | 55.0 ± 2.8 | 65.0 ± 2.8 | 75.6 ± 4.9 | <0.001 |
IVST in diastole, mm | 10.9 ± 2.4 | 11.6 ± 2.2 | 11.2 ± 2.2 | 11.6 ± 2.3 | <0.001 |
PWT in diastole, mm | 10.5 ± 2.2 | 11.1 ± 2.2 | 10.9 ± 1.9 | 11.2 ± 2.0 | <0.001 |
Any combined valvular disease (moderate or severe)∗ | 303 (51) | 278 (50) | 543 (39) | 428 (35) | <0.001 |
Moderate or severe AR | 135 (23) | 138 (25) | 277 (20) | 239 (19) | 0.03 |
Moderate or severe MS | 14 (2) | 22 (4) | 54 (4) | 43 (3) | 0.37 |
Moderate or severe MR | 211 (36) | 152 (27) | 240 (17) | 155 (13) | <0.001 |
Moderate or severe TR | 127 (21) | 101 (18) | 223 (16) | 175 (14) | <0.001 |
TR PG ≥40 mm Hg∗ | 142 (24) | 105 (19) | 176 (13) | 181 (15) | <0.001 |
Treatment strategy | |||||
Initial AVR | 206 (35) | 170 (30) | 375 (27) | 440 (35) | <0.001 |
Conservative | 388 (65) | 390 (70) | 1,025 (73) | 800 (65) |
Values are mean ± SD or n (%).
AR = aortic regurgitation; AVA = aortic valve area; AVR = aortic valve replacement; BMI = body mass index; BSA = body surface area; CABG = coronary artery bypass grafting; EuroSCORE = European System for Cardiac Operative Risk Evaluation; HF = heart failure; IVST = interventricular septal thickness; LV = left ventricular; LVEF = left ventricular ejection fraction; MR = mitral regurgitation; MS = mitral stenosis; PCI = percutaneous coronary intervention; PG = pressure gradient; PROM = Predicted Risk of Mortality; PWT = posterior wall thickness; STS = Society of Thoracic Surgeons; TR = tricuspid regurgitation; Vmax = peak aortic jet velocity.