Low left ventricular end-systolic elastance was a significant independent predictor of all-cause mortality in patients with aortic stenosis (aHR 1.59; 95% CI 1.13-2.25; p=0.009).
Cohort (n=693)
Does left ventricular end-systolic elastance predict all-cause mortality in patients with mild-severe aortic stenosis?
Low left ventricular end-systolic elastance is an independent prognostic marker for worse all-cause mortality in patients with aortic stenosis.
Hazard Ratio: 1.59 (95% CI 1.13–2.25)
p-value: p=0.009
Abstract Background Aortic stenosis (AS) is a heterogenous group of conditions where left ventricular afterload excess results in a reduction in ejection fraction (EF), stroke volume (SV) and flow states over time. In the context of left ventriculo-arterial coupling (VAC), we sought to evaluate the impact of left ventricular end-systolic elastance, or force, a load-independent marker of cardiac contractility on AS. Methods Between 2011 to 2021, 693 consecutive patients with index echocardiographic diagnoses of mild-severe AS were stratified into 3 groups: low force ( 33rd percentile, 2.98mmHg/ml), intermediate force (≥33rd and ≤67th percentile, 2.98-4.92mmHg/ml), and high force (67th percentile, 4.92 mmHg/ml). Baseline demographics were collected, and a Kaplan-Meier curve and multivariate Cox regression model constructed. Results Of 229 patients included with low force, majority were males (57.2%, n = 131), younger (mean age 73.1+12.3), had higher NYHA IV symptoms (p=0.031), more incidences of coronary artery disease (p0.001), atrial fibrillation (p0.001), end stage kidney disease (p=0.010), and elevated biomarkers of creatinine (p=0.009) and NTproBNP (p=0.003). From high to low force, the 3 groups showed descending values for systolic blood pressure (SBP), LVEF and VAC (p0.001); while low to high force groups showed descending values for end-diastolic volume (EDV) and end-systolic volume (ESV) (p0.001) Severe AS was associated with low force while mild AS was associated with high force (p=0.018). Classical low-flow low-gradient AS was associated with significantly lower force (p0.001). Low force patients were followed up over a shorter duration 3.5+3.4 years (p0.001), and underwent more surgical AV intervention (p=0.009) over a shorter duration at 2.0+2.3 years (p=0.020). Low force state was a significant independent predictor of all-cause mortality in AS (aHR 1.59, CI: 1.13-2.25, p=0.009) after adjustments for age, sex, BMI, diabetes mellitus, coronary artery disease, atrial fibrillation, chronic kidney disease, malignancy, anemia, initial LVEF, and absence of AV intervention. Conclusions Low force or left ventricular end-systolic elastance states were associated with worse symptomology, comorbidities, more surgical AV intervention and was a prognostic marker of worse all-cause mortality in AS.Multivariate Time to Event Analyses Kaplan-Meier Curves by Force
Ong et al. (Sat,) conducted a cohort in Aortic stenosis (n=693). Low left ventricular end-systolic elastance (<33rd percentile, <2.98mmHg/ml) vs. Intermediate and high left ventricular end-systolic elastance was evaluated on All-cause mortality (aHR 1.59, 95% CI 1.13-2.25, p=0.009). Low left ventricular end-systolic elastance was a significant independent predictor of all-cause mortality in patients with aortic stenosis (aHR 1.59; 95% CI 1.13-2.25; p=0.009).