Inadequately low left ventricular mass in patients with significant aortic stenosis predicts favourable prognostic outcomes
In patients with significant aortic stenosis (AS), the prognostic effect of the increase in left ventricular mass (LVM) in relation to one’s hemodynamic load has been described. Inappropriately high LVM has been shown to predict adverse cardiovascular events. However, little is known about the progn...
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| Veröffentlicht in: | The International Journal of Cardiovascular Imaging 2021-05, Vol.37 (5), p.1611-1619 |
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| creator | Chew, Nicholas W. S. Ngiam, Jinghao Nicholas Tan, Benjamin Yong-Qiang Sia, Ching-Hui Ruan, Wen Sim, Hui-Wen Kong, William K. F. Tay, Edgar L. W. Yeo, Tiong-Cheng Poh, Kian Keong |
| description | In patients with significant aortic stenosis (AS), the prognostic effect of the increase in left ventricular mass (LVM) in relation to one’s hemodynamic load has been described. Inappropriately high LVM has been shown to predict adverse cardiovascular events. However, little is known about the prognostic impact of inadequately low LVM (i-lowLVM) in patients with significant AS. I-lowLVM was defined as the measured LVM |
| doi_str_mv | 10.1007/s10554-020-02146-3 |
| format | Article |
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S. ; Ngiam, Jinghao Nicholas ; Tan, Benjamin Yong-Qiang ; Sia, Ching-Hui ; Ruan, Wen ; Sim, Hui-Wen ; Kong, William K. F. ; Tay, Edgar L. W. ; Yeo, Tiong-Cheng ; Poh, Kian Keong</creator><creatorcontrib>Chew, Nicholas W. S. ; Ngiam, Jinghao Nicholas ; Tan, Benjamin Yong-Qiang ; Sia, Ching-Hui ; Ruan, Wen ; Sim, Hui-Wen ; Kong, William K. F. ; Tay, Edgar L. W. ; Yeo, Tiong-Cheng ; Poh, Kian Keong</creatorcontrib><description>In patients with significant aortic stenosis (AS), the prognostic effect of the increase in left ventricular mass (LVM) in relation to one’s hemodynamic load has been described. Inappropriately high LVM has been shown to predict adverse cardiovascular events. However, little is known about the prognostic impact of inadequately low LVM (i-lowLVM) in patients with significant AS. I-lowLVM was defined as the measured LVM < 73% of the predicted LVM based on sex, stroke work and height from the reference adult population, used in previous established studies. For outcome analysis, the end-point was defined as all-cause mortality, aortic valve replacement and/or admission for congestive heart failure. Kaplan–Meier curves and multivariable Cox regression models were constructed to compare outcomes on follow-up. During the follow-up (4.5 ± 4.1 years), 132 patients (11.1%) had i-lowLVM, 868 (73.1%) had adequate-LVM, 188 (15.8%) had inappropriately high LVM. Outcome analysis only included patients with i-lowLVM and adequate-LVM (N = 1000). An adverse composite event occurred in 41.7% of the i-lowLVM group and 52.4% of the adequate-LVM group (p = 0.021). Event-free survival in patients with i-lowLVM and appropriate-LVM was 76% versus 68% at 2-year, 55% versus 46% at 4-year, 33% versus 27% at 6-year, 20% versus 17% at 8-year, and 17% versus 11% at 10-year follow-up, respectively (p < 0.001). Cox analysis revealed that i-lowLVM was independently associated with lower composite adverse outcome (HR 0.624, 95% CI 0.460–0.846, p = 0.002) after adjusting for sex, age, ejection fraction, ischemic heart disease, diabetes and transaortic valve mean gradient. In the separate Cox subanalyses, the presence of i-lowLVM remained a predictor of lower composite adverse outcome in the severe AS subgroup (HR 0.587, 95% CI 0.396–0.870, p = 0.008), and the LVH subgroup (HR 0.574, 95% CI 0.401–0.824, p = 0.003) after adjusting for confounders. I-lowLVM despite significant AS may represent a distinct group that is associated with improved survival outcomes independent of other prognostic covariates.</description><identifier>ISSN: 1569-5794</identifier><identifier>EISSN: 1573-0743</identifier><identifier>EISSN: 1875-8312</identifier><identifier>DOI: 10.1007/s10554-020-02146-3</identifier><identifier>PMID: 33454894</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Aorta ; Aortic stenosis ; Aortic valve ; Blood pressure ; Body height ; Cardiac Imaging ; Cardiology ; Cardiovascular diseases ; Congestive heart failure ; Coronary artery disease ; Diabetes mellitus ; Ejection fraction ; Heart diseases ; Heart failure ; Heart valves ; Hemodynamics ; Hypertension ; Imaging ; Ischemia ; Medicine ; Medicine & Public Health ; Mortality ; Original Paper ; Radiology ; Regression analysis ; Regression models ; Rheumatic heart disease ; Sex ; Stenosis ; Stroke ; Subgroups ; Survival ; Ventricle</subject><ispartof>The International Journal of Cardiovascular Imaging, 2021-05, Vol.37 (5), p.1611-1619</ispartof><rights>The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature 2021</rights><rights>The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-f50a920e8a090a828662f2d9232fa6f52a366e45a51b4d0a4d4c1bb99e9a5a2b3</citedby><cites>FETCH-LOGICAL-c375t-f50a920e8a090a828662f2d9232fa6f52a366e45a51b4d0a4d4c1bb99e9a5a2b3</cites><orcidid>0000-0002-0640-0430</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10554-020-02146-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10554-020-02146-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33454894$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chew, Nicholas W. S.</creatorcontrib><creatorcontrib>Ngiam, Jinghao Nicholas</creatorcontrib><creatorcontrib>Tan, Benjamin Yong-Qiang</creatorcontrib><creatorcontrib>Sia, Ching-Hui</creatorcontrib><creatorcontrib>Ruan, Wen</creatorcontrib><creatorcontrib>Sim, Hui-Wen</creatorcontrib><creatorcontrib>Kong, William K. F.</creatorcontrib><creatorcontrib>Tay, Edgar L. W.</creatorcontrib><creatorcontrib>Yeo, Tiong-Cheng</creatorcontrib><creatorcontrib>Poh, Kian Keong</creatorcontrib><title>Inadequately low left ventricular mass in patients with significant aortic stenosis predicts favourable prognostic outcomes</title><title>The International Journal of Cardiovascular Imaging</title><addtitle>Int J Cardiovasc Imaging</addtitle><addtitle>Int J Cardiovasc Imaging</addtitle><description>In patients with significant aortic stenosis (AS), the prognostic effect of the increase in left ventricular mass (LVM) in relation to one’s hemodynamic load has been described. Inappropriately high LVM has been shown to predict adverse cardiovascular events. However, little is known about the prognostic impact of inadequately low LVM (i-lowLVM) in patients with significant AS. I-lowLVM was defined as the measured LVM < 73% of the predicted LVM based on sex, stroke work and height from the reference adult population, used in previous established studies. For outcome analysis, the end-point was defined as all-cause mortality, aortic valve replacement and/or admission for congestive heart failure. Kaplan–Meier curves and multivariable Cox regression models were constructed to compare outcomes on follow-up. During the follow-up (4.5 ± 4.1 years), 132 patients (11.1%) had i-lowLVM, 868 (73.1%) had adequate-LVM, 188 (15.8%) had inappropriately high LVM. Outcome analysis only included patients with i-lowLVM and adequate-LVM (N = 1000). An adverse composite event occurred in 41.7% of the i-lowLVM group and 52.4% of the adequate-LVM group (p = 0.021). Event-free survival in patients with i-lowLVM and appropriate-LVM was 76% versus 68% at 2-year, 55% versus 46% at 4-year, 33% versus 27% at 6-year, 20% versus 17% at 8-year, and 17% versus 11% at 10-year follow-up, respectively (p < 0.001). Cox analysis revealed that i-lowLVM was independently associated with lower composite adverse outcome (HR 0.624, 95% CI 0.460–0.846, p = 0.002) after adjusting for sex, age, ejection fraction, ischemic heart disease, diabetes and transaortic valve mean gradient. In the separate Cox subanalyses, the presence of i-lowLVM remained a predictor of lower composite adverse outcome in the severe AS subgroup (HR 0.587, 95% CI 0.396–0.870, p = 0.008), and the LVH subgroup (HR 0.574, 95% CI 0.401–0.824, p = 0.003) after adjusting for confounders. I-lowLVM despite significant AS may represent a distinct group that is associated with improved survival outcomes independent of other prognostic covariates.</description><subject>Aorta</subject><subject>Aortic stenosis</subject><subject>Aortic valve</subject><subject>Blood pressure</subject><subject>Body height</subject><subject>Cardiac Imaging</subject><subject>Cardiology</subject><subject>Cardiovascular diseases</subject><subject>Congestive heart failure</subject><subject>Coronary artery disease</subject><subject>Diabetes mellitus</subject><subject>Ejection fraction</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart valves</subject><subject>Hemodynamics</subject><subject>Hypertension</subject><subject>Imaging</subject><subject>Ischemia</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Original Paper</subject><subject>Radiology</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Rheumatic heart disease</subject><subject>Sex</subject><subject>Stenosis</subject><subject>Stroke</subject><subject>Subgroups</subject><subject>Survival</subject><subject>Ventricle</subject><issn>1569-5794</issn><issn>1573-0743</issn><issn>1875-8312</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1TAQhi0Eohd4ARbIEhs2AcfXeIkqoJUqsYG1NXHsg6skPvU4rSpeHh9OAYkFC2usmW9-j-cn5FXP3vWMmffYM6Vkxzhrp5e6E0_Iaa-M6JiR4unhrm2njJUn5AzxhrGGcvGcnAghlRysPCU_rlaYwu0GNcwPdM73dA6x0ruw1pL8NkOhCyDStNI91NTSSO9T_U4x7dYUk4e1UsilJk-xhjVjQrovYUq-kRHu8lZgnEPL5V2rHri8VZ-XgC_IswgzhpeP8Zx8-_Tx68Vld_3l89XFh-vOC6NqFxUDy1kYgFkGAx-05pFPlgseQUfFQWgdpALVj3JiICfp-3G0NlhQwEdxTt4eddsMt1vA6paEPswzrCFv6Lg0gzFaKd7QN_-gN-0Da5vOccW51dII2Sh-pHzJiCVEty9pgfLgeuYO1rijNa7t2_2yxonW9PpRehuXMP1p-e1FA8QRwFZad6H8ffs_sj8B0VucCA</recordid><startdate>20210501</startdate><enddate>20210501</enddate><creator>Chew, Nicholas W. 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S. ; Ngiam, Jinghao Nicholas ; Tan, Benjamin Yong-Qiang ; Sia, Ching-Hui ; Ruan, Wen ; Sim, Hui-Wen ; Kong, William K. F. ; Tay, Edgar L. 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S.</creatorcontrib><creatorcontrib>Ngiam, Jinghao Nicholas</creatorcontrib><creatorcontrib>Tan, Benjamin Yong-Qiang</creatorcontrib><creatorcontrib>Sia, Ching-Hui</creatorcontrib><creatorcontrib>Ruan, Wen</creatorcontrib><creatorcontrib>Sim, Hui-Wen</creatorcontrib><creatorcontrib>Kong, William K. F.</creatorcontrib><creatorcontrib>Tay, Edgar L. W.</creatorcontrib><creatorcontrib>Yeo, Tiong-Cheng</creatorcontrib><creatorcontrib>Poh, Kian Keong</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>The International Journal of Cardiovascular Imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chew, Nicholas W. S.</au><au>Ngiam, Jinghao Nicholas</au><au>Tan, Benjamin Yong-Qiang</au><au>Sia, Ching-Hui</au><au>Ruan, Wen</au><au>Sim, Hui-Wen</au><au>Kong, William K. F.</au><au>Tay, Edgar L. W.</au><au>Yeo, Tiong-Cheng</au><au>Poh, Kian Keong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inadequately low left ventricular mass in patients with significant aortic stenosis predicts favourable prognostic outcomes</atitle><jtitle>The International Journal of Cardiovascular Imaging</jtitle><stitle>Int J Cardiovasc Imaging</stitle><addtitle>Int J Cardiovasc Imaging</addtitle><date>2021-05-01</date><risdate>2021</risdate><volume>37</volume><issue>5</issue><spage>1611</spage><epage>1619</epage><pages>1611-1619</pages><issn>1569-5794</issn><eissn>1573-0743</eissn><eissn>1875-8312</eissn><abstract>In patients with significant aortic stenosis (AS), the prognostic effect of the increase in left ventricular mass (LVM) in relation to one’s hemodynamic load has been described. Inappropriately high LVM has been shown to predict adverse cardiovascular events. However, little is known about the prognostic impact of inadequately low LVM (i-lowLVM) in patients with significant AS. I-lowLVM was defined as the measured LVM < 73% of the predicted LVM based on sex, stroke work and height from the reference adult population, used in previous established studies. For outcome analysis, the end-point was defined as all-cause mortality, aortic valve replacement and/or admission for congestive heart failure. Kaplan–Meier curves and multivariable Cox regression models were constructed to compare outcomes on follow-up. During the follow-up (4.5 ± 4.1 years), 132 patients (11.1%) had i-lowLVM, 868 (73.1%) had adequate-LVM, 188 (15.8%) had inappropriately high LVM. Outcome analysis only included patients with i-lowLVM and adequate-LVM (N = 1000). An adverse composite event occurred in 41.7% of the i-lowLVM group and 52.4% of the adequate-LVM group (p = 0.021). Event-free survival in patients with i-lowLVM and appropriate-LVM was 76% versus 68% at 2-year, 55% versus 46% at 4-year, 33% versus 27% at 6-year, 20% versus 17% at 8-year, and 17% versus 11% at 10-year follow-up, respectively (p < 0.001). Cox analysis revealed that i-lowLVM was independently associated with lower composite adverse outcome (HR 0.624, 95% CI 0.460–0.846, p = 0.002) after adjusting for sex, age, ejection fraction, ischemic heart disease, diabetes and transaortic valve mean gradient. In the separate Cox subanalyses, the presence of i-lowLVM remained a predictor of lower composite adverse outcome in the severe AS subgroup (HR 0.587, 95% CI 0.396–0.870, p = 0.008), and the LVH subgroup (HR 0.574, 95% CI 0.401–0.824, p = 0.003) after adjusting for confounders. I-lowLVM despite significant AS may represent a distinct group that is associated with improved survival outcomes independent of other prognostic covariates.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>33454894</pmid><doi>10.1007/s10554-020-02146-3</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0640-0430</orcidid></addata></record> |
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| subjects | Aorta Aortic stenosis Aortic valve Blood pressure Body height Cardiac Imaging Cardiology Cardiovascular diseases Congestive heart failure Coronary artery disease Diabetes mellitus Ejection fraction Heart diseases Heart failure Heart valves Hemodynamics Hypertension Imaging Ischemia Medicine Medicine & Public Health Mortality Original Paper Radiology Regression analysis Regression models Rheumatic heart disease Sex Stenosis Stroke Subgroups Survival Ventricle |
| title | Inadequately low left ventricular mass in patients with significant aortic stenosis predicts favourable prognostic outcomes |
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