A new non-invasive index for prognosis evaluation in patients with aortic stenosis

Abstract

The global left ventricular (LV) contractility index, d?*/dtmax measures the maximal rate of change in pressure-normalized LV wall stress. We aim to describe the trend of d?*/dtmax in differing severity of aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) and the association of d?*/dtmax with clinical outcomes in moderate AS and severe AS. We retrospectively studied a total of 1738 patients with AS (550 mild AS, 738 moderate AS, 450 severe AS) and preserved LVEF ? 50% diagnosed from 1st January 2001 to 31st December 2015. d?*/dtmax worsened with increasing severity of AS despite preserved LVEF (mild AS: 3.69 ± 1.28 s?1, moderate AS: 3.17 ± 1.09 s?1, severe AS: 2.58 ± 0.83 s?1, p < 0.001). Low d?*/dtmax < 2.8 s?1 was independently associated with a higher composite outcome of aortic valve replacement, congestive cardiac failure admissions and all-cause mortality (adjusted hazard ratio 1.48, 95% CI: 1.25–1.77, p < 0.001). In conclusion, d?*/dtmax declined with worsening AS despite preserved LVEF. Low d?*/dtmax < 2.8 s?1 was independently associated with adverse clinical outcomes in moderate AS and severe AS with preserved LVEF. © 2020, The Author(s).