Impact of left atrial and diastolic ventricular dysfunction on mortality in patients with aortic stenosis - 11/03/23
Highlights |
• | DD is frequent in patients with SAS, despite no or mild AS-related symptoms. |
• | ASE/EACVI DD grades are associated with mortality in these patients. |
• | PALS≤14% refines the prognostic value of DD grades. |
• | Patients with grade III or grade II DD and PALS≤14% have a high mortality risk. |
• | A comprehensive assessment of diastolic function is needed in patients with SAS. |
Abstract |
Background |
Diastolic dysfunction (DD) is common in severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF≥50%).
Aim |
To determine the impact of American Society of Echocardiography/European Association of Cardiovascular Imaging-recommended DD grading and left atrial strain on mortality in a cohort of patients with severe AS and preserved LVEF.
Methods |
We studied patients with severe AS (aortic valve area indexed<0.6 cm2/m2 and/or aortic valve area<1cm2), LVEF≥50% and no or mild AS-related symptoms. The endpoint was all-cause mortality.
Results |
A total of 387 patients (median age 76years; 53% women) were studied. During a median follow-up of 57 (interquartile range 37; 83) months, 158 patients died. After adjustment for prognostic factors, patients with grade II or III DD had an increased mortality risk versus patients with grade I DD (adjusted hazard ratio (aHR) 1.62, 95% confidence interval (CI) 1.11–2.38; P=0.013; aHR 4.73, 95% CI 2.49–8.99; P<0.001; respectively). Adding peak atrial longitudinal strain (PALS)≤14% to a multivariable model including DD grade improved predictive performance, with better global model fit, reclassification and discrimination. Patients with grade III DD or grade II DD+PALS≤14% displayed an increased mortality risk versus patients with grade I DD+PALS>14% (aHR 4.17, 95% CI 2.46–7.06; P<0.0001). Those with grade I DD+PALS≤14% or grade II DD+PALS>14% were at intermediate risk (aHR 1.63, 95% CI 1.07–2.49; P=0.024).
Conclusions |
Our results demonstrate the strong relationship between DD and mortality in patients with severe AS and preserved LVEF. Patients with grade III or grade II DD and impaired PALS are at very high risk. These data demonstrate the importance of a comprehensive assessment of diastolic function in patients with severe AS.
Le texte complet de cet article est disponible en PDF.Keywords : Aortic stenosis, Diastolic dysfunction, Left atrial strain, Outcome
Abbreviations : aHR, AS, ASE, AVA, AVR, CI, DD, EACVI, IDI, IQR, LA, LACS, LAS, LV, LVEF, NRI, PACS, PALS
Plan
☆ | Tweet: Cumulative importance of diastolic dysfunction grades and left atrial strain for the risk stratification of patients with severe aortic stenosis, and no or mild AS-related symptoms #aortic stenosis #strain #diastole. Twitter handle: @MarechauxSyl (S. Maréchaux). |
Vol 116 - N° 3
P. 126-135 - mars 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.