PMID- 28494976
OWN - NLM
STAT- MEDLINE
DCOM- 20170724
LR  - 20171224
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 69
IP  - 19
DP  - 2017 May 16
TI  - Prognostic Implications of Moderate Aortic Stenosis in Patients With 
      Left Ventricular Systolic Dysfunction.
PG  - 2383-2392
LID - S0735-1097(17)36134-X [pii]
LID - 10.1016/j.jacc.2017.03.023 [doi]
AB  - BACKGROUND: Left ventricular (LV) systolic dysfunction and moderate aortic 
      stenosis (AS) are more frequent with advancing age and often coexist. Afterload 
      reduction is the mainstay of pharmacological treatment of heart failure (HF). 
      Aortic valve replacement (AVR) is only formally indicated for symptomatic severe 
      AS. OBJECTIVES: This study sought to determine the clinical outcome of patients 
      with concomitant moderate AS and LV systolic dysfunction. METHODS: 
      Echocardiographic and clinical data of patients with moderate AS and LV systolic 
      dysfunction between 2010 and 2015 from 4 large academic institutions were 
      retrospectively analyzed. Moderate AS was defined as aortic valve area between 
      1.0 and 1.5 cm(2) and LV systolic dysfunction defined as LV ejection 
      fraction <50%. The primary endpoint was a composite of all-cause death, AVR, and 
      HF hospitalization. RESULTS: A total of 305 patients (mean age 73 +/- 11 years; 75% 
      male) were included. The majority were symptomatic at the time of index 
      echocardiogram (New York Heart Association [NYHA] functional class II: 42%; NYHA 
      functional class III: 28%; and NYHA functional class IV: 4%). Ischemic heart 
      disease was present in 72% of patients. At 4-year follow-up, the primary 
      composite endpoint occurred in 61%. The main predictors for the primary endpoint 
      were male sex (p = 0.022), NYHA functional class III or IV (p < 0.001), and peak 
      aortic jet velocity (p < 0.001). The rate of the composite of all-cause death or 
      HF hospitalization was 48%, rate of all-cause death was 36%, and rate of HF 
      hospitalization was 27%. AVR occurred in 24% of patients. CONCLUSIONS: Patients 
      with concomitant moderate AS and LV systolic dysfunction are at high risk for 
      clinical events. Further studies are needed to determine if earlier AVR in these 
      patients might improve clinical outcome.
CI  - Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - van Gils, Lennart
AU  - van Gils L
AD  - Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
FAU - Clavel, Marie-Annick
AU  - Clavel MA
AD  - Department of Cardiology, Quebec Heart and Lung Institute/Laval University, 
      Quebec City, Quebec, Canada.
FAU - Vollema, E Mara
AU  - Vollema EM
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Hahn, Rebecca T
AU  - Hahn RT
AD  - Department of Cardiology, New York-Presbyterian Hospital/Columbia University 
      Medical Center, New York, New York.
FAU - Spitzer, Ernest
AU  - Spitzer E
AD  - Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
FAU - Delgado, Victoria
AU  - Delgado V
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Nazif, Tamim
AU  - Nazif T
AD  - Department of Cardiology, New York-Presbyterian Hospital/Columbia University 
      Medical Center, New York, New York.
FAU - De Jaegere, Peter P
AU  - De Jaegere PP
AD  - Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
FAU - Geleijnse, Marcel L
AU  - Geleijnse ML
AD  - Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
FAU - Ben-Yehuda, Ori
AU  - Ben-Yehuda O
AD  - Department of Cardiology, New York-Presbyterian Hospital/Columbia University 
      Medical Center, New York, New York.
FAU - Bax, Jeroen J
AU  - Bax JJ
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Leon, Martin B
AU  - Leon MB
AD  - Department of Cardiology, New York-Presbyterian Hospital/Columbia University 
      Medical Center, New York, New York.
FAU - Pibarot, Philippe
AU  - Pibarot P
AD  - Department of Cardiology, Quebec Heart and Lung Institute/Laval University, 
      Quebec City, Quebec, Canada.
FAU - Van Mieghem, Nicolas M
AU  - Van Mieghem NM
AD  - Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands. 
      Electronic address: n.vanmieghem@erasmusmc.nl.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2017 May 16;69(19):2393-2396. PMID: 28494977
CIN - J Thorac Dis. 2017 Oct;9(10 ):3529-3532. PMID: 29268333
CIN - J Thorac Dis. 2017 Oct;9(10 ):3560-3563. PMID: 29268341
CIN - J Thorac Dis. 2017 Oct;9(10 ):3590-3593. PMID: 29268349
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/*complications/diagnostic imaging/mortality
MH  - Echocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Admission/statistics & numerical data
MH  - Retrospective Studies
MH  - Ventricular Dysfunction, Left/*complications/diagnostic imaging/mortality
OTO - NOTNLM
OT  - heart failure
OT  - outcomes
OT  - peak aortic jet velocity
OT  - surgical aortic valve replacement
OT  - transcatheter aortic valve replacement
EDAT- 2017/05/13 06:00
MHDA- 2017/07/25 06:00
CRDT- 2017/05/13 06:00
PHST- 2016/12/30 00:00 [received]
PHST- 2017/03/06 00:00 [revised]
PHST- 2017/03/09 00:00 [accepted]
PHST- 2017/05/13 06:00 [entrez]
PHST- 2017/05/13 06:00 [pubmed]
PHST- 2017/07/25 06:00 [medline]
AID - S0735-1097(17)36134-X [pii]
AID - 10.1016/j.jacc.2017.03.023 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2017 May 16;69(19):2383-2392. doi: 10.1016/j.jacc.2017.03.023.