The first-phase ejection fraction - association with outcome in aortic valve stenosis. (8th February 2021)

• Record Type: Journal Article
• Authors: Carter-Storch, R; Mortensen, NSB; Christensen, NL; Ali, M; Laursen, K; Pellikka, PA; Moeller, JE; Dahl, JS
• Is Part Of: European heart journal. Volume 22(2021)Supplement 1
• Publication Date: 2021-02-08
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa356.362
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: Foundation. Main funding source(s): Danish Heart Association. Background: First-phase ejection fraction (EF1), the ejection fraction (EF) until the time of peak systolic flow may be a sensitive marker of subclinical left ventricular (LV) dysfunction. This study investigated the prognostic value of EF1 in asymptomatic and symptomatic severe aortic stenosis (AS). Methods: This study included 94 asymptomatic and 108 symptomatic patients with severe AS. The prognostic value of EF1 was compared with other echocardiographic markers and magnetic resonance imaging (MRI) measured end-systolic wall stress and late gadolinium enhancement fibrosis (LGE). Asymptomatic patients were followed up for 3.0 years (primary outcome death or aortic valve replacement). Symptomatic patients were followed up for 4.3 years (primary outcome death). Results: In multivariate regression analysis wall stress (p < 0.001) and LGE (p = 0.03) were associated with EF1. In the asymptomatic cohort EF1 was significantly associated with the end-point, especially among the subgroup of patients with a mean gradient < 40 mmHg (HR 0.91, p = 0.005), while global longitudinal strain was not. In the surgical cohort, EF1 was borderline associated with death (p = 0.08) which was significant after correction for LGE (HR 0.90, p = 0.02). Conclusion: EF1 is a predictor of death or AVR in asymptomatic AS, especially among discordantly graded patients with low area and low gradient.