Department of Cardiology, Odense University Hospital, Odense, Denmark
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Open Heart. 2021 Feb;8(1). doi: 10.1136/openhrt-2020-001543.
First-phase ejection fraction (EF1), the left ventricular (LV) ejection fraction (EF) until the time of peak transaortic velocity, is a novel marker of subclinical LV dysfunction able to predict adverse events in aortic stenosis (AS). This study investigated the association between end-systolic wall stress (ESWS) and EF1 in severe AS, as well as the prognostic value of EF1 in severe asymptomatic AS.
Two prospectively gathered cohorts of 94 asymptomatic patients and 108 symptomatic patients scheduled for aortic valve replacement (AVR), all with severe AS (aortic valve area <1 cm) were stratified according to the median value of EF1 (33%). EF1 was defined as the EF at peak transaortic velocity. Asymptomatic patients were followed up for 3 years for the combined end-point of death, AVR or admission with heart failure.
EF1 correlated with EF and was inversely associated with ESWS. In multivariate regression analysis, ESWS (p<0.001) and replacement fibrosis measured by MRI (p=0.02) were associated with EF1. Among asymptomatic patients, EF1 above the median was associated with the combined primary endpoint (HR=0.53 (95% CI 0.33 to 0.87)), while global longitudinal strain and EF were not. Among 42 patients with discordant AS (mean gradient <40 mm Hg), EF1 above median was associated with the primary endpoint (HR 0.28 (95% CI 0.12 to 0.61)).
EF1 is an afterload-dependent measure that is associated with events in patients with asymptomatic severe AS. The afterload dependency of EF1 may be useful in timing of risk stratification in patients with discordant AS.
NCT02395107 and NCT02316587.
第一时相射血分数（EF1），即左心室射血分数（EF）直至峰值跨主动脉速度的时间，是一种能够预测主动脉瓣狭窄（AS）不良事件的亚临床左心室功能障碍的新型标志物。本研究旨在探讨严重 AS 患者终末期壁应力（ESWS）与 EF1 的相关性，以及 EF1 在无症状严重 AS 患者中的预后价值。
前瞻性收集了两个队列，共纳入 94 例无症状患者和 108 例有症状患者，所有患者均因严重 AS（主动脉瓣面积 <1cm）而接受主动脉瓣置换术（AVR），并根据 EF1（33%）的中位数将患者分为两组。EF1 定义为峰值跨主动脉速度时的 EF。无症状患者接受了 3 年的随访，主要终点为死亡、AVR 或因心力衰竭住院。
EF1 与 EF 相关，与 ESWS 呈负相关。在多变量回归分析中，ESWS（p<0.001）和 MRI 测量的替换纤维化（p=0.02）与 EF1 相关。在无症状患者中，EF1 高于中位数与主要终点相关（HR=0.53（95%CI 0.33 至 0.87）），而整体纵向应变和 EF 则没有。在 42 例平均梯度<40mmHg 的 AS 不匹配患者中，EF1 高于中位数与主要终点相关（HR 0.28（95%CI 0.12 至 0.61））。
EF1 是一种与无症状严重 AS 患者事件相关的依赖后负荷的指标。EF1 的后负荷依赖性可能有助于对 AS 不匹配患者进行风险分层的时机选择。
NCT02395107 和 NCT02316587。
