First phase ejection fraction in aortic stenosis: A useful new measure of early left ventricular systolic dysfunction

TY - JOUR

T1 - First phase ejection fraction in aortic stenosis

T2 - A useful new measure of early left ventricular systolic dysfunction

AU - Saeed, Sahrai

AU - Gu, Haotian

AU - Rajani, Ronak

AU - Chowienczyk, Phil

AU - Chambers, John B.

N1 - Publisher Copyright: © 2021 The Authors. Journal of Clinical Ultrasound published by Wiley Periodicals LLC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/11/1

Y1 - 2021/11/1

N2 - In aortic stenosis (AS), a left ventricular (LV) ejection fraction (EF) <50% or symptoms are class I indications for aortic valve intervention. However, an EF <50% may be too conservative since subendocardial fibrosis may already have developed. An earlier marker of LV systolic dysfunction is therefore needed and first phase EF (EF1) is a promising new candidate. It is the EF measured over early systole to the point of maximum transaortic blood flow. It may be low in the presence of preserved total LV EF since the heart may compensate by recruiting myosin motors in later systole. The EF1 is inversely related to the grade of AS and directly related to markers of subendocardial fibrosis like late gadolinium enhancement on cardiac magnetic resonance scanning. A reduced EF1 (<25%) predicts adverse clinical events better that total EF and global longitudinal strain. We suggest that it is worth exploring as an indication for surgery in patients with asymptomatic severe AS.

AB - In aortic stenosis (AS), a left ventricular (LV) ejection fraction (EF) <50% or symptoms are class I indications for aortic valve intervention. However, an EF <50% may be too conservative since subendocardial fibrosis may already have developed. An earlier marker of LV systolic dysfunction is therefore needed and first phase EF (EF1) is a promising new candidate. It is the EF measured over early systole to the point of maximum transaortic blood flow. It may be low in the presence of preserved total LV EF since the heart may compensate by recruiting myosin motors in later systole. The EF1 is inversely related to the grade of AS and directly related to markers of subendocardial fibrosis like late gadolinium enhancement on cardiac magnetic resonance scanning. A reduced EF1 (<25%) predicts adverse clinical events better that total EF and global longitudinal strain. We suggest that it is worth exploring as an indication for surgery in patients with asymptomatic severe AS.

KW - aortic stenosis

KW - echocardiography

KW - ejection fraction

KW - first phase ejection fraction

KW - prognosis

KW - systolic left ventricular function

UR - http://www.scopus.com/inward/record.url?scp=85114596516&partnerID=8YFLogxK

U2 - 10.1002/jcu.23063

DO - 10.1002/jcu.23063

M3 - Article

AN - SCOPUS:85114596516

SN - 0091-2751

VL - 49

SP - 932

EP - 935

JO - Journal of Clinical Ultrasound

JF - Journal of Clinical Ultrasound

IS - 9

ER -