PMID- 32345658
OWN - NLM
STAT- MEDLINE
DCOM- 20210628
LR  - 20240214
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Print)
IS  - 1355-6037 (Linking)
VI  - 106
IP  - 16
DP  - 2020 Aug
TI  - Determinants and prognostic value of echocardiographic first-phase ejection 
      fraction in aortic stenosis.
PG  - 1236-1243
LID - 10.1136/heartjnl-2020-316684 [doi]
AB  - OBJECTIVE: First-phase ejection fraction (EF1) is a novel measure of early left 
      ventricular systolic dysfunction. We investigated determinants of EF1 and its 
      prognostic value in aortic stenosis. METHODS: EF1 was measured retrospectively in 
      participants of an echocardiography/cardiovascular magnetic resonance cohort 
      study which recruited patients with aortic stenosis (peak aortic velocity of >/=2 
      m/s) between 2012 and 2014. Linear regression models were constructed to examine 
      variables associated with EF1. Cox proportional hazards were used to determine 
      the prognostic power of EF1 for aortic valve replacement (AVR, performed as part 
      of clinical care in accordance with international guidelines) or death. RESULTS: 
      Total follow-up of the 149 participants (69.8% male, 70 (65-76) years, mean 
      gradient 33 (21-42) mm Hg) was 238 029 person-days. Sixty-seven participants 
      (45%) had a low baseline EF1 (<25%) despite normal ejection fraction (67% 
      (62%-71%)). Patients with low EF1 had more severe aortic stenosis (mean gradient 
      39 (34-45) mm Hg vs 24 (16-35) mm Hg, p<0.001) and more myocardial fibrosis 
      (indexed extracellular volume (iECV) (24.2 (19.6-28.7) mL/m(2) vs 20.6 
      (16.8-24.3) mL/m(2), p=0.002; late gadolinium enhancement (LGE) prevalence 52% vs 
      20%, p<0.001). Zva, iECV and infarct LGE were independent predictors of EF1. EF1 
      improved post-AVR (n=57 with post-AVR EF1 available, baseline 16 (12-24) vs 
      follow-up 27% (22%-31%); p<0.001). Low baseline EF1 was an independent predictor 
      of AVR/death (HR 5.6, 95% CI 3.4 to 9.4), driven by AVR. CONCLUSION: EF1 
      quantifies early, potentially reversible systolic dysfunction in aortic stenosis, 
      is associated with global afterload and myocardial fibrosis, and is an 
      independent predictor of AVR.
CI  - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published 
      by BMJ.
FAU - Bing, Rong
AU  - Bing R
AUID- ORCID: 0000-0002-8305-4906
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK 
      rong.bing@ed.ac.uk.
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
FAU - Gu, Haotian
AU  - Gu H
AD  - BHF Centre of Research Excellence, King's College London, London, UK.
FAU - Chin, Calvin
AU  - Chin C
AUID- ORCID: 0000-0002-9867-4390
AD  - Cardiovascular Medicine, National Heart Center Singapore, Singapore.
FAU - Fang, Lingyun
AU  - Fang L
AD  - BHF Centre of Research Excellence, King's College London, London, UK.
FAU - White, Audrey
AU  - White A
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
FAU - Everett, Russell J
AU  - Everett RJ
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
FAU - Spath, Nicholas B
AU  - Spath NB
AUID- ORCID: 0000-0001-9623-0158
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
FAU - Park, Eunsoo
AU  - Park E
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
FAU - Jenkins, William Sa
AU  - Jenkins WS
AUID- ORCID: 0000-0001-8872-0413
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
FAU - Shah, Anoop Sv
AU  - Shah AS
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
FAU - Mills, Nicholas L
AU  - Mills NL
AUID- ORCID: 0000-0003-0533-7991
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
FAU - Flapan, Andrew D
AU  - Flapan AD
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
FAU - Chambers, John B
AU  - Chambers JB
AUID- ORCID: 0000-0002-7169-3786
AD  - Guy's and Saint Thomas' Hospitals NHS Trust, London, UK.
FAU - Newby, David E
AU  - Newby DE
AUID- ORCID: 0000-0001-7971-4628
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
FAU - Chowienczyk, Phil
AU  - Chowienczyk P
AD  - BHF Centre of Research Excellence, King's College London, London, UK.
AD  - Guy's and Saint Thomas' Hospitals NHS Trust, London, UK.
FAU - Dweck, Marc R
AU  - Dweck MR
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
AD  - BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, 
      UK.
LA  - eng
GR  - ICA-CL-2018-04-ST2-012/DH_/Department of Health/United Kingdom
GR  - PG/19/40/34422/BHF_/British Heart Foundation/United Kingdom
GR  - FS/14/78/31020/BHF_/British Heart Foundation/United Kingdom
GR  - TG/17/2/33054/BHF_/British Heart Foundation/United Kingdom
GR  - RG/16/10/32375/BHF_/British Heart Foundation/United Kingdom
GR  - WT103782AIA/WT_/Wellcome Trust/United Kingdom
GR  - FS/16/14/32023/BHF_/British Heart Foundation/United Kingdom
GR  - MC_PC_15031/MRC_/Medical Research Council/United Kingdom
GR  - WT_/Wellcome Trust/United Kingdom
GR  - PG/19/23/34259/BHF_/British Heart Foundation/United Kingdom
GR  - RE/13/3/30183/BHF_/British Heart Foundation/United Kingdom
GR  - CH/09/002/26360/BHF_/British Heart Foundation/United Kingdom
GR  - RE/18/5/34216/BHF_/British Heart Foundation/United Kingdom
GR  - CH/09/002/BHF_/British Heart Foundation/United Kingdom
GR  - MR/M016560/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20200428
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
CIN - Heart. 2020 Aug;106(16):1200-1201. PMID: 32546507
CIN - Heart. 2020 Nov;106(22):1778-1779. PMID: 32907825
CIN - Heart. 2020 Nov;106(22):1778. PMID: 32907826
MH  - Aged
MH  - Aortic Valve/*diagnostic imaging/pathology/physiopathology
MH  - Aortic Valve Stenosis/*diagnostic imaging/pathology/physiopathology
MH  - *Echocardiography
MH  - Female
MH  - Fibrosis
MH  - *Hemodynamics
MH  - Humans
MH  - Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Middle Aged
MH  - Myocardium/pathology
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Retrospective Studies
MH  - *Stroke Volume
MH  - *Ventricular Function, Left
PMC - PMC7418600
OTO - NOTNLM
OT  - aortic stenosis
OT  - cardiac magnetic resonance (CMR) imaging
OT  - echocardiography
OT  - valve disease surgery
COIS- Competing interests: HG and PC are named on a patent for the use of first-phase 
      ejection fraction (WO2017144851A1).
EDAT- 2020/04/30 06:00
MHDA- 2021/06/29 06:00
PMCR- 2020/08/11
CRDT- 2020/04/30 06:00
PHST- 2020/02/03 00:00 [received]
PHST- 2020/03/13 00:00 [revised]
PHST- 2020/04/02 00:00 [accepted]
PHST- 2020/04/30 06:00 [pubmed]
PHST- 2021/06/29 06:00 [medline]
PHST- 2020/04/30 06:00 [entrez]
PHST- 2020/08/11 00:00 [pmc-release]
AID - heartjnl-2020-316684 [pii]
AID - 10.1136/heartjnl-2020-316684 [doi]
PST - ppublish
SO  - Heart. 2020 Aug;106(16):1236-1243. doi: 10.1136/heartjnl-2020-316684. Epub 2020 
      Apr 28.