Abstract
BackgroundIt is unclear whether increased left ventricular (LV) thickness is associated with worse clinical outcomes in severe aortic stenosis (AS). The aim of this study was to determine the effect of increased LV wall thickness (LVWT) on major clinical outcomes in patients with severe AS.Methods and resultsThis study included 290 severe AS patients (mean age 69.4 ± 11.0 years; 136 females) between January 2008 and December 2018. For outcome assessment, the endpoint was defined as death from all causes, cardiovascular death, and the aortic valve replacement (AVR) surgery rate. During follow-up (48.7 ± 39.0 months), 157 patients had AVR, 43 patients died, and 28 patients died from cardiovascular causes. Patients with increased LVWT underwent AVR surgery much more than those without LVWT (60.0% vs. 39.0%, p < 0.001). Furthermore, in patients with increased LVWT, the all-cause and cardiovascular death rates were significantly lower in the AVR group than in the non-AVR group (8.8% vs. 27.3%, p < 0.001, 4.8%, vs. 21.0%, p < 0.001). Multivariate analysis revealed that increased LVWT, age, dyspnea, and AVR surgery were significantly correlated with cardiovascular death.ConclusionsIn patients with severe AS, increased LVWT was associated with a higher AVR surgery rate and an increased rate of cardiovascular death independent of other well-known prognostic variates. Thus, these findings suggest that increased LVWT might be used as a potential prognostic factor in severe AS patients.
Highlights
It is unclear whether increased left ventricular (LV) thickness is associated with worse clinical outcomes in severe aortic stenosis (AS)
In patients with severe AS, increased LV wall thickness (LVWT) was associated with a higher aortic valve replacement (AVR) surgery rate and an increased rate of cardiovascular death independent of other well-known prognostic variates
Thirty-two patients with normal LVWT (39.0%) underwent AVR, whereas AVR was performed in 125 patients with increased LVWT (60.0%) (p < 0.001)
Summary
It is unclear whether increased left ventricular (LV) thickness is associated with worse clinical outcomes in severe aortic stenosis (AS). LVH in patients with aortic stenosis (AS) is characterized by increased left ventricular mass (LVM), which is the main compensatory mechanism to reduce systolic wall stress and preserve cardiac output. Progression of LVH in patients with AS may predate onset of symptoms and excessive LVH is associated with adverse outcome even in asymptomatic severe AS patients [9]. It is not included in the current indications of AVR [8]. We aimed to examine the association of the presence of LVH determined by preoperative echocardiography with clinical outcomes in severe AS patients
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