Clinical and echocardiographic outcomes of patients with moderate to severe aortic stenosis and preserved, mid-range and reduced ejection fraction

Abstract

Abstract Background Left ventricular ejection fraction (EF) plays an important role in risk stratifying and guiding therapy for patients with aortic stenosis (AS). This study aims to describe the clinical and echocardiographic outcomes of AS patients with preserved (ASpEF), mid-range (ASmrEF) and reduced (ASrEF) EF. Methods 713 consecutive patients with index echocardiographic diagnosis of moderate-severe AS (aortic valve area <1.5cm2) were allocated according to the EF into three groups: ASrEF (EF<40%), ASmrEF (EF 40–50%), and ASpEF (EF>50%). The study outcomes were defined as 5-year all-cause mortality, heart failure admissions, and aortic valve replacement (AVR). Results In comparison to patients with ASpEF, those with ASrEF were more frequently male, and systolic blood pressure was significantly lower on enrolment (p<0.001). Diabetes, ischemic heart disease and atrial fibrillation were more commonly seen in the ASrEF and ASmrEF groups, compared to ASpEF group. All-cause mortality rates were 30.5% for ASpEF, 50.8% for ASmrEF, 55.0% for ASrEF groups (p<0.001). Increased rates of heart failure admissions were seen in the ASmrEF and ASrEF groups (30.5% and 33.9%, respectively, vs. 14.9% in ASpEF group). Patients with ASrEF had significantly higher rates of AVR as compared to those in the ASmrEF and ASpEF groups (p=0.032). Conclusion Echocardiographic and clinical outcomes of ASmrEF patients resembled those of ASrEF more closely than the ASpEF patients. Stratifying AS patients according to the different EF groups may improve risk assessment and treatment strategies. Figure 1 Funding Acknowledgement Type of funding source: None