Low myocardial energetic efficiency is associated with increased mortality in aortic stenosis.
Aged
Anticholesteremic Agents
/ therapeutic use
Aortic Valve
/ diagnostic imaging
Aortic Valve Stenosis
/ diagnosis
Double-Blind Method
Echocardiography, Doppler
Energy Metabolism
/ physiology
Europe
/ epidemiology
Ezetimibe
/ therapeutic use
Follow-Up Studies
Humans
Middle Aged
Myocardium
/ metabolism
Prognosis
Prospective Studies
Simvastatin
/ therapeutic use
Stroke Volume
/ physiology
Survival Rate
/ trends
Ventricular Function, Left
/ physiology
aortic valve stenosis
echocardiography
health care
outcome assessment
Journal
Open heart
ISSN: 2053-3624
Titre abrégé: Open Heart
Pays: England
ID NLM: 101631219
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
13
05
2021
accepted:
02
08
2021
entrez:
24
8
2021
pubmed:
25
8
2021
medline:
15
12
2021
Statut:
ppublish
Résumé
In hypertension, low myocardial energetic efficiency (MEEi) has been documented as an integrated marker of metabolic and left ventricular (LV) myocardial dysfunction. We tested the predictive performance of MEEi in initially asymptomatic aortic stenosis (AS) patients free from diabetes and known cardiovascular disease. Data from 1703 patients with mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study followed for 4.3 years was used. MEE was calculated from Doppler stroke volume/([heart rate/60]) and indexed to LV mass (MEEi). The threshold value for MEEi associated with increased mortality was identified in generalised additive model with smoothing splines. Covariables of MEEi were identified in logistic regression analysis. Outcome was assessed in Cox regression analysis and reported as HR and 95% CI. MEEi <0.34 mL/s per gram was associated with increased cardiovascular mortality (n=80) (HR 2.53 (95% CI 1.50 to 4.28)) and all-cause mortality (n=155) (HR 1.74 (95% CI 1.20 to 2.52)) (both p<0.01). The association was independent of confounders of low MEEI (<0.34 mL/s per gram) identified in multivariable logistic regression analysis, including more severe AS, higher body mass index, lower LV midwall shortening and ejection fraction and presence of hypertension. Comparison of the Cox models with and without MEEi among the covariables demonstrated that MEEi significantly improved the prognostic yield (both p<0.01). In patients with initially asymptomatic AS, low MEEi was associated with clustering of cardiometabolic risk factors, lower LV myocardial function and subsequent increased mortality during 4.3 years follow-up, independent of known prognosticators. NCT00092677.
Identifiants
pubmed: 34426527
pii: openhrt-2021-001720
doi: 10.1136/openhrt-2021-001720
pmc: PMC8383869
pii:
doi:
Substances chimiques
Anticholesteremic Agents
0
Simvastatin
AGG2FN16EV
Ezetimibe
EOR26LQQ24
Banques de données
ClinicalTrials.gov
['NCT00092677']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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