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First-phase ejection fraction is a powerful predictor of adverse events in asymptomatic patients with aortic stenosis and preserved total ejection fraction

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
JournalJACC Cardiovascular Imaging
Early online date15 Nov 2018
Accepted/In press30 Aug 2018
E-pub ahead of print15 Nov 2018


King's Authors


Objectives First-phase ejection fraction (EF1), the ejection fraction up to the time of maximal ventricular contraction may be more sensitive than existing markers in detecting early systolic dysfunction. We examined the prognostic value of EF1 in patients with aortic stenosis (AS), a condition in which left ventricular dysfunction as measured by conventional indices is an indication for valve replacement. Methods The predictive value of EF1 compared to conventional echocardiographic indices for outcomes was assessed in 218 asymptomatic patients with at least moderate AS, including 73 with moderate, 50 with severe and 96 with "discordant" (aortic area < 1.0 cm2 and gradient < 40 mmHg) AS, all with preserved EF, followed for at least 2 years. EF1 was measured retrospectively from archived echocardiographic images by wall tracking of the endocardium. The primary outcome was a combined event of aortic valve intervention, hospitalisation for cardiac causes and death from any cause. Results EF1 was the most powerful predictor of events in the total population and all sub-groups. A cut-off value of 25% gave hazard ratios (for EF1<25% compared to ≥25%) of 27.7, (95% confidence interval 13.1-58.7, P<0.001) unadjusted, and 24.4 (11.3-52.7, P<0.001) adjusted for other echocardiographic measures including global longitudinal strain, for events at 2-years in all patients with asymptomatic AS. Corresponding hazard ratios for all-cause mortality in the total population were 17.5 (5.7-53.3) and 17.4 (5.5-55.2) unadjusted and adjusted respectively. Conclusion EF1 may be potentially valuable in the clinical management of patients with AS and other conditions in which there is progression from early to late systolic dysfunction.

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