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

Abstract

The global left ventricular (LV) contractility index, dσ*/dt_max measures the maximal rate of change in pressure-normalized LV wall stress. We aim to describe the trend of dσ*/dt_max in differing severity of aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) and the association of dσ*/dt_max 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 1^st January 2001 to 31^st December 2015. dσ*/dt_max 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 dσ*/dt_max < 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, dσ*/dt_max declined with worsening AS despite preserved LVEF. Low dσ*/dt_max < 2.8 s⁻¹ was independently associated with adverse clinical outcomes in moderate AS and severe AS with preserved LVEF.