Aims: Left ventricular (LV) hypertrophy and abnormal non-invasive measures of LV diastolic function are common in patients with severe aortic stenosis (AS) but their prognostic importance is uncertain. This study aimed to determine whether tissue Doppler measures of LV systolic and/or diastolic function or echocardiographic LV hypertrophy are useful for risk stratifying asymptomatic patients with severe calcific AS.
Methods and results: One hundred and eighty-three initially asymptomatic patients with moderate or severe AS (valve area mean 0.96 ± SD 0.3 cm(2)) and a normal LV ejection fraction were followed for median 31 (IQR 14-40) months. Peak systolic (S') and diastolic (E') mitral annular velocities and LV mass were measured by echocardiography at baseline and during follow-up. During follow-up 106 (58%) patients suffered symptomatic deterioration, including three sudden deaths and one resuscitated cardiac arrest. Peak aortic velocity (for 0.5 m/s increase HR = 1.43, 95% CI 1.25, 1.64, P < 0.0001) and aortic valve area (-0.1 cm(2)/m(2) HR = 1.23, 95% CI 1.12, 1.35, P = 0.004) at baseline were most strongly associated with symptomatic deterioration. After peak aortic velocity adjustment neither LV mass index nor any measure of LV systolic or diastolic function was associated with symptomatic deterioration (P > 0.2 for all).
Conclusion: In patients with calcific AS who have a normal LV ejection fraction the severity of stenosis is the most important correlate of symptomatic deterioration. Tissue Doppler measures of LV systolic and diastolic function and LV mass provide limited predictive information after accounting for the severity of stenosis.