How long should we wait with asymptomatic aortic stenosis and preserved LVEF?

Courtesy of Dr. Carlos Fava.

Asymptomatic severe aortic stenosis with preserved ventricular function is challenging. At present, it remains unclear whether we should operate or not and, according to some recent reports, neither do we know what patients will benefit from surgery.

Anillo pequeño, ¿debemos comenzar a elegir la válvula?The study looked at 1678 patients with asymptomatic or minimally asymptomatic severe aortic stenosis. 1108 of these patients (66%) presented left ventricular ejection fraction (LVEF) >60%, 331 (20%) between 55% and 59%, and 239 (14%) <55%.

 

Mean age was 76, the group that presented LVEF <55% were mostly men and had high atrial fibrillation and infarction, larger ventricular diameters and volumes and lower gradient.


Read also: Asymptomatic Severe Aortic Stenosis in the Elderly: When to Intervene.


758 patients received medical treatment: 469 (62%) with LVEF >60%, 167 (22%) with LVEF between 55-59% and 122 (16%) with LVEF <55%. On the other hand, the remaining 920 patients received surgery within 3 months after the eco-Doppler: 639 (60%) with LVEF >60%, 164 (18%) with LVEF 55-59% and 117 (13%) with LVEF <55%.

 

Survival at 5 years was 72% for patients with LVEF >60%, 74% for patients with LVEF between 55-59% and 59% for LVEF <55% (p >0.001). After multivariable analysis, no differences were found for patients with LVEF >60% and 55-59%, but there was higher mortality among patients with LVEF <55%.


Read also: Safety in Abdominal Aortic Aneurysm Surveillance Programs.


This was observed both in patients receiving surgery and in patients receiving medical treatment. LVEF <55% was the cutoff value for mortality increase.

 

Conclusion

In patients with asymptomatic severe aortic stenosis and preserved ventricular function (or with minimal symptoms at the time of diagnosis) ventricular ejection fraction <55% is a marker of poor outcome, with medical management or surgery. Therefore, we suggest considering surgery before patients reach this stage.

 

Gentileza del Dr. Carlos Fava.

 

Original Title: Relationship Between Left Ventricular Ejection Fraction and Mortality in Asymptomatic and Minimally Symptomatic Patients with Severe Aortic Stenosis.

Reference: Yohann Bohbot, et al. J Am Coll Cardiol Img 2018 Article in Press


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Prospective Analysis of the Feasibility of the PASCAL System for Transcatheter Mitral Repair: OneForAll Registry

Courtesy of Dr. Juan Manuel Pérez. Mitral transcatheter edge-to-edge repair (M-TEER) is an effective option for patients with severe mitral regurgitation who are at high...

Left Bundle Branch Block after TAVR: What Is Its Impact?

Courtesy of Dr. Juan Manuel Pérez. Left bundle branch block (LBBB) is a common complication following transcatheter aortic valve replacement (TAVR), which can be either...

Multicenter Experience with 3D Intracardiac Echocardiography for Guiding Interventional Cardiac Procedures

Courtesy of Dr. Juan Manuel Pérez. Imaging techniques play a fundamental role in interventional cardiac procedures. Intracardiac echocardiography (ICE) appears as an alternative to transesophageal...

Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening

Courtesy of Dr. Juan Manuel Pérez. Despite the available long term followup data on of transcatheter aortic valve replacement (TAVR), bioprosthesis durability continues under debate....

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...