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You are here: Contents > 2016 > Volume 25 Number 1 January 2016 > AORTIC VALVE DISEASE > Value of Combined Circumferential and Longitudinal Left Ventricular Systolic Dysfunction to Predict Adverse Outcome in Patients with Asymptomatic Aortic Stenosis

Value of Combined Circumferential and Longitudinal Left Ventricular Systolic Dysfunction to Predict Adverse Outcome in Patients with Asymptomatic Aortic Stenosis

Giovanni Cioffi1, Carmine Mazzone2, Giulia Barbati2, Andrea Rossi3, Stefano Nistri4, Federica Ognibeni1, Luigi Tarantini5, Andrea Di Lenarda2, Pompilio Faggiano6, Giovanni Pulignano7, Carlo Stefenelli1, Giovanni de Simone8

1Department of Cardiology, Villa Bianca Hospital, Trento, 2Cardiovascular Center, Health Authority no. 1 and University of Trieste, 3Division of Cardiology, Department of Medicine, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, 4Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Vicenza, 5Department of Cardiology, Ospedale civile S. Martino, Belluno, 6Cardiology Unit, Spedali Civili, Brescia, 7Heart Failure Clinic, Division of Cardiology/CCU, San Camillo Hospital, Rome, 8Department of Translational Medical Sciences, Federico II, University Hospital, School of Medicine, Naples, Italy

Background and aim of the study: Patients with asymptomatic aortic stenosis (AS) may have left ventricular systolic dysfunction (LVSD) defined as an impairment of the circumferential and/or longitudinal (C&L) myocardial fibers, despite a preserved left ventricular ejection fraction (LVEF). An assessment was made as to whether the combined LVSD of C&L fibers has a prognostic impact in asymptomatic AS.

Methods: A total of 200 asymptomatic AS patients was analyzed. Midwall shortening and mitral annular peak systolic velocity were considered as indices of C&L function and classified as low if <16.5% and <8.5 cm/s, respectively. The primary outcome was a composite of major cardiovascular events (MACE), including aortic valve-related and ischemic cardiovascular-related events.

Results: During a 25-month follow up period, MACE occurred in 69 patients (35%),

while 46 of 72 patients (64%) had C&L LVSD and 23 of 128 patients (18%) had not (p <0.001). Cox analysis identified C&L LVSD as an independent MACE predictor, together with aortic transvalvular peak gradient, E/E′ ratio and excessive left ventricular mass. C&L-LVSD also predicted the occurrence of aortic valve-related events and ischemic cardiovascular-related events analyzed separately. A receiver operating characteristic curve analysis showed that the area under the curve (AUC) for C&L LVSD in predicting MACE was 0.77, significantly higher (p = 0.002, z-statistic) than the AUCs of C&L fibers considered individually (0.64 and 0.63, respectively).

Conclusion: C&L-LVSD provides additional prognostic information into traditional risk factors for patients with asymptomatic AS.

 The Journal of Heart Valve Disease 2015;24:28-38


Value of Combined Circumferential and Longitudinal Left Ventricular Systolic Dysfunction to Predict Adverse Outcome in Patients with Asymptomatic Aortic Stenosis

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