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Review Article | Volume 25 Issue 1 (, 2019) | Pages 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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1
Department of Cardiology, Villa Bianca Hospital, Trento.
2
Cardiovascular Center, Health Authority no. 1 and University of Trieste.
3
Division of Cardiology, Department of Medicine, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona.
4
Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Vicenza.
5
Department of Cardiology, Ospedale civile S. Martino, Belluno.
6
Cardiology Unit, Spedali Civili, Brescia.
7
Heart Failure Clinic, Division of Cardiology/CCU, San Camillo Hospital, Rome.
8
Department of Translational Medical Sciences, Federico II, University Hospital, School of Medicine, Naples, Italy.
Under a Creative Commons license
PMID : -27989081
Published
Jan. 11, 2016
Abstract

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.

 

 

 

How to cite: Cioffi, G., Mazzone, C., Barbati, G., Rossi, A., Nistri, S., Ognibeni, F., Tarantini, L., Di Lenarda, A., Faggiano, P., Pulignano, G., Stefenelli, C., & de Simone, G. (2016). Value of Combined Circumferential and Longitudinal Left Ventricular Systolic Dysfunction to Predict Adverse Outcome in Patients with Asymptomatic Aortic Stenosis. The Journal of heart valve disease25(1), 28–38.

 
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