Giudicatti, L. C.,
Markers of elevated left ventricular filling pressure are associated with increased mortality in nonsevere aortic stenosis.
Journal of the American Society of Echocardiography, 34 (5), 465-471.
Background: Echocardiographic measures of elevated left ventricular filling pressures are associated with an adverse prognosis. The aim of this study was to determine the relationship between acute (ratio of early transmitral flow to mitral annular velocities; E/e’) and chronic (indexed left atrial volume; LAVI) markers of left ventricular filling pressure (LVFP) and mortality in patients with non-severe aortic stenosis (AS), within the National Echo Database of Australia cohort. We hypothesised that they would reflect the early haemodynamic consequences of AS and be associated with increased mortality in this setting.
Methods: The first record for patients 18 years or over showing hemodynamically significant but non-severe (mild or moderate) AS (mean pressure gradient ≥10 to <40mmHg and AVA>1cm2) was analysed. Baseline demographics and echocardiographic variables were compared to patients without AS (mean pressure gradient <10mmHg). Mortality linkage data were available for all patients.
Results: Of 78,886 patients with aortic valve mean pressure gradient <40mmHg and AVA>1cm2, 13,768 (17%) were identified with non-severe AS (aortic valve mean pressure gradient 10-40mmHg), of which 57% were male (mean age 73 ±13.4 years) with a median follow-up of 3.4 years (interquartile range: 1.7-6.1 years). In unadjusted models, non-severe AS and a LAVI>34ml/m2 [Hazard Ratio (HR)=2.29 (95% CI 2.03-2.58)], an E/e’>14 [HR=2.27 (95% CI 2.08-2.49)], a left ventricular ejection fraction (LVEF) <50% [HR 2.82 (95% CI 2.50-3.19)], and a tricuspid regurgitation (TR) peak velocity>280cm/s [HR=2.54 (95% CI 2.30-2.80)] were associated with increased mortality hazard. The effect remained independent when combined in a multi-variable model.
Conclusions: Indices of elevated LVFP are independently associated with death in non-severe AS. Risk stratification models incorporating these variables may identify patients at risk of complications, warranting closer surveillance and possibly earlier intervention.
echocardiography, observational, aortic stenosis, left ventricular filling pressure, mortality