Usefulness of velocity ratio in patients with moderate aortic stenosis and reduced left ventricular ejection fraction.
Hirokazu OnishiMasaki IzumoToru NaganumaSatoru MitomoTatsuya NakaoYukio SatoMika WatanabeKazuaki OkuyamaRyo KamijimaYasuhiro TanabeYoshihiro J AkashiSunao NakamuraPublished in: Scandinavian cardiovascular journal : SCJ (2021)
Background. Moderate aortic stenosis (AS) increases left ventricular afterload and results in unfavorable outcomes in patients with reduced left ventricular ejection fraction (LVEF). Velocity ratio (VR) may be appropriate for the evaluation of aortic valve (AV) hemodynamics because of the low dependence on flow. Therefore, this study investigated the usefulness of VR on the clinical outcomes of such patients. Method. Clinical data of patients with moderate AS (AV area, 0.60-0.85 cm2/m2; peak AV velocity, 2.0-4.0 m/s) and reduced LVEF (LVEF 20-50%) were analyzed during 2010-2018. VR was calculated as peak left ventricular outflow tract velocity/peak AV velocity. The primary endpoint included all-cause death, heart failure hospitalization, and AV replacement. Results. In total, 104 patients (mean age, 75.9 ± 7.0 years; 62.5% men) were included. LVEF was 39.5% ± 7.8%. The AV area was 0.72 ± 0.08 cm2/m2, peak AV velocity was 2.59 ± 0.40 m/s, and VR was 0.30 ± 0.07. The follow-up period was 1.7 (0.5-3.5) years. Kaplan-Meier estimates for the endpoint were 59.9% at 3 years. Multivariable analysis revealed that VR (hazard ratio, 0.947; 95% confidence interval, 0.905-0.990; p = .018) was significantly related to this endpoint. Patients with a VR <0.25 had significantly higher incidence rates of the endpoint than those with a VR ≥0.25 (85.6% versus 47.8% at 3 years; p < .001). Conclusions. Patients with moderate AS and reduced LVEF have unfavorable clinical outcomes, particularly those with low VR.
Keyphrases
- aortic stenosis
- ejection fraction
- aortic valve replacement
- transcatheter aortic valve implantation
- virtual reality
- left ventricular
- aortic valve
- heart failure
- transcatheter aortic valve replacement
- blood flow
- cardiac resynchronization therapy
- metabolic syndrome
- newly diagnosed
- acute myocardial infarction
- type diabetes
- end stage renal disease
- chronic kidney disease
- left atrial
- weight loss
- glycemic control
- acute heart failure