Author + information
- Received May 21, 2019
- Revision received August 15, 2019
- Accepted September 5, 2019
- Published online December 16, 2019.
- Eri Minamino-Muta, MDa,
- Takao Kato, MDa,∗ (, )
- Takeshi Morimoto, MD, MPHb,
- Tomohiko Taniguchi, MDa,
- Chisato Izumi, MDc,
- Kenji Nakatsuma, MDa,
- Moriaki Inoko, MDd,
- Shinichi Shirai, MDe,
- Norio Kanamori, MDf,
- Koichiro Murata, MDg,
- Takeshi Kitai, MDh,
- Yuichi Kawase, MDi,
- Makoto Miyake, MDj,
- Hirokazu Mitsuoka, MDk,
- Yutaka Hirano, MDl,
- Tomoki Sasa, MDm,
- Kazuya Nagao, MDn,
- Tsukasa Inada, MDn,
- Ryusuke Nishikawa, MDo,
- Yasuyo Takeuchi, MDo,
- Shintaro Matsuda, MDa,
- Keiichiro Yamane, MDp,
- Kanae Su, MDq,
- Akihiro Komasa, MDa,
- Katsuhisa Ishii, MDr,
- Yoshihiro Kato, MDs,
- Kensuke Takabayashi, MDt,
- Shin Watanabe, MDa,
- Naritatsu Saito, MDa,
- Kenji Minatoya, MDu,
- 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
- cDivision of Heart Failure, National Cerebral and Cardiovascular Center, Suita, Japan
- dCardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
- eDepartment of Cardiology, Kokura Memorial Hospital, Kokura, Japan
- fDivision of Cardiology, Shimada Municipal Hospital, Shimada, Japan
- gDepartment of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
- hDepartment of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- iDepartment of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
- jDepartment of Cardiology, Tenri Hospital, Tenri, Japan
- kDivision of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
- lDepartment of Cardiology, Kinki University Hospital, Osakasayama, Japan
- mKishiwada City Hospital, Kishiwada, Japan
- nDepartment of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
- oDepartment of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
- pDepartment of Cardiology, Nishikobe Medical Center, Kobe, Japan
- qDepartment of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
- rDepartment of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
- sDepartment of Cardiology, Saiseikai Noe Hospital, Osaka, Japan
- tDepartment of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
- uDepartment of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- ↵∗Address for correspondence:
Dr. Takao Kato, Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Objectives The 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.
Background No previous study has explored the association between LVEF decline during follow-up and clinical outcomes in patients with severe AS.
Methods Among 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.
Results There 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).
Conclusions Patients 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)
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 May 21, 2019.
- Revision received August 15, 2019.
- Accepted September 5, 2019.
- 2019 American College of Cardiology Foundation
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