Left ventricular asymmetric remodeling and subclinical left ventricular dysfunction in patients with calcific aortic valve stenosis – Results from a subanalysis of the PROGRESSA study. (1st June 2021)

• Record Type: Journal Article
• Authors: Bernard, Jérémy; Tastet, Lionel; Capoulade, Romain; Shen, Mylène; Clisson, Marine; Guzzetti, Ezequiel; Larose, Éric; Arsenault, Marie; Bédard, Élisabeth; Côté, Nancy; Clavel, Marie-Annick; Pibarot, Philippe
• Is Part Of: International journal of cardiology. Volume 332(2021)
• Page Start: 148
• Page End: 156
• Publication Date: 2021-06-01
• Subjects: LV asymmetric remodeling -- Aortic stenosis -- Age -- Global LV longitudinal strain -- Natriuretic peptides -- Doppler echocardiography; AS aortic valve stenosis -- ASE American Society of Echocardiography -- AVA aortic valve area -- AVC aortic valve calcification -- CI confidence interval -- EACVI European Association of Cardiovascular Imaging -- LV left ventricular -- LVAR left ventricular asymmetric remodeling -- LV-GLS left ventricular global longitudinal strain -- MACE major adverse cardiac events -- MG mean gradient -- Vpeak peak aortic jet velocity -- OR odds ratio -- Zva valvulo-arterial impedance; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.03.017
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: LV asymmetric remodeling (LVAR) is a feature commonly found in AS patients and it is presumed to be mainly related to the severity of valve stenosis. The aim of this study was to determine the associated factors and impact on left ventricular (LV) systolic function of LVAR in patients with mild and moderate aortic valve stenosis (AS). Methods: Clinical, Doppler-echocardiographic and computed-tomographic data of 155 AS patients with preserved LV ejection fraction (≥50%) prospectively recruited in the PROGRESSA study (NCT01679431 ) were analyzed. LVAR was defined as a septal wall thickness ≥ 13 mm and a ratio of septal/posterior wall thickness > 1.5. LV global longitudinal strain (LV-GLS) was available in 129 patients. Plasma levels of N-terminal natriuretic B-type peptides (Nt-proBNP) were also measured. Results: Mean age was 63 ± 15 years (70% men). LVAR was present in 21% ( n = 33) of patients. A series of nested multivariate analysis revealed that age was the only factor associated with LVAR (all p ≤ 0.03). Additionally, these patients had higher baseline Nt-proBNP ratio (median [25–75 percentiles]: 1.04 [0.66–2.41] vs. 0.65 [0.33–1.19], p = 0.02), and significantly reduced LV-GLS (17.9[16.6–19.5] vs. 19.3[17.4–20.7] |%|, p = 0.04). A 1:1 matched analysis showed a significant association of LVAR with reduced LV-GLS (17.9[16.6–19.5] vs. 19.8[18.1–20.7] |%|, p = 0.02) and elevated Nt-proBNP (134[86–348] vs. 83[50–179]pg/ml, p = 0.03). Multivariable analysis also revealed that LVAR remains significantly associated with reduced LV-GLS ( p = 0.03) and elevated Nt-proBNP ( p = 0.001). LVAR was significantly associated with increased risk of major adverse cardiac events and death (Hazard ratio [95% confidence interval]: 2.32[1.28–4.22], p = 0.006). Conclusions: LVAR was found in ~20% of patients with mild or moderate AS and was not related to the degree of AS severity or concomitant comorbidities, but rather to older age. LVAR was significantly associated with reduced LV longitudinal systolic function, increased Nt-proBNP levels, and higher risk of major adverse events and death. These findings provide support for closer clinical and echocardiographic surveillance of patients harboring this adverse LV remodeling feature. Graphical Abstract: Prevalence, Echocardiographic criteria, Factors Associated, Outcomes and Clinical Implications of LV Asymmetric Remodeling in Patients with Calcific Aortic Valve Stenosis Caption : The figure illustrates in bold the associated factors and impacts on outcomes of having LVAR in presence of mild-moderate AS patients, highlighted by this present study. LVAR presence is characterised by a septal wall thickness ≥ 13 mm & the septal/posterior wall thickness ratio > 1.5. Older patients with at least one of known factors associated and the presence of LVAR should be closely monitored because of the presence of LV damage and subclinical LV dysfunction in these patients. The combination of global longitudinal function by strain analysis and regular measurements of biomarkers such as Nt-proBNP should be closely monitored in these patients. LV: left ventricular, LVAR: LV asymmetric remodeling, AS: aortic stenosis. Unlabelled Image Highlights: LVAR is present in 15 to 30% of patients with mild-to-moderate AS. Age is strongly and independently correlated to the presence of LVAR in mild-to-moderate AS. Presence of LVAR in AS patients provides a simple echocardiographic marker of LV damage and subclinical dysfunction. LVAR may be implicated in the development or progression of LV systolic dysfunction and the occurrence of adverse events in these patients.