TY - JOUR
T1 - Relation of the Mitral Annular Plane Systolic Excursion to Risk for Intervention in Initially Asymptomatic Patients With Aortic Stenosis and Preserved Systolic Function
AU - Matos, Jason D.
AU - Kiss, Joshua E.
AU - Locke, Andrew H.
AU - Goldberg, Randal I.
AU - Mukamal, Kenneth
AU - Manning, Warren J.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Aortic valve intervention (AVI) in patients with a severe aortic stenosis (AS) and a preserved left ventricular ejection fraction (LVEF) is controversial. Mitral annular plane systolic excursion (MAPSE) is an easily acquired metric of left ventricular longitudinal shortening. We sought to investigate if an asymptomatic decrease in MAPSE preceded the need for AVI in asymptomatic patients with AS and a preserved LVEF. In this retrospective cohort study, we identified 205 consecutive patients (56% male, 73 ± 11 years) with at least a moderate AS and a normal LVEF who underwent a serial outpatient transthoracic echocardiography (TTE) from 2006 to 2013. Apical TTE images were reviewed and (the average of septal, lateral, anterior, and inferior) MAPSE was measured. We examined the association of change in MAPSE with aortic valve area and LVEF over time and used time-varying Cox models to examine the risk of AVI. MAPSE correlated with aortic valve area (Spearman r = 0.18, p = 0.02) and decreased with subsequent TTE, whereas LVEF was “maintained.” For each 1-mm reduction in MAPSE, the age- and gender-adjusted hazard ratio (HR) for AVI was 1.15 (95% confidence interval [CI] 1.01 to 1.31, p = 0.04). A MAPSE decrease of >2 mm/TTE was significantly associated with an increased risk of AVI, with an adjusted HR of 1.95 (95% CI 1.04 to 3.66, p = 0.04), whereas a MAPSE decrease of >1.5 mm/year trended toward an association with an increased risk of AVI (HR 1.61, 95% CI 0.95 to 2.74, p = 0.08). In conclusion, in asymptomatic patients with at least a moderate AS and a preserved LVEF, an asymptomatic decrease in MAPSE was associated with the clinical need for AVI despite ongoing preservation of LVEF.
AB - Aortic valve intervention (AVI) in patients with a severe aortic stenosis (AS) and a preserved left ventricular ejection fraction (LVEF) is controversial. Mitral annular plane systolic excursion (MAPSE) is an easily acquired metric of left ventricular longitudinal shortening. We sought to investigate if an asymptomatic decrease in MAPSE preceded the need for AVI in asymptomatic patients with AS and a preserved LVEF. In this retrospective cohort study, we identified 205 consecutive patients (56% male, 73 ± 11 years) with at least a moderate AS and a normal LVEF who underwent a serial outpatient transthoracic echocardiography (TTE) from 2006 to 2013. Apical TTE images were reviewed and (the average of septal, lateral, anterior, and inferior) MAPSE was measured. We examined the association of change in MAPSE with aortic valve area and LVEF over time and used time-varying Cox models to examine the risk of AVI. MAPSE correlated with aortic valve area (Spearman r = 0.18, p = 0.02) and decreased with subsequent TTE, whereas LVEF was “maintained.” For each 1-mm reduction in MAPSE, the age- and gender-adjusted hazard ratio (HR) for AVI was 1.15 (95% confidence interval [CI] 1.01 to 1.31, p = 0.04). A MAPSE decrease of >2 mm/TTE was significantly associated with an increased risk of AVI, with an adjusted HR of 1.95 (95% CI 1.04 to 3.66, p = 0.04), whereas a MAPSE decrease of >1.5 mm/year trended toward an association with an increased risk of AVI (HR 1.61, 95% CI 0.95 to 2.74, p = 0.08). In conclusion, in asymptomatic patients with at least a moderate AS and a preserved LVEF, an asymptomatic decrease in MAPSE was associated with the clinical need for AVI despite ongoing preservation of LVEF.
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U2 - 10.1016/j.amjcard.2017.08.021
DO - 10.1016/j.amjcard.2017.08.021
M3 - Article
C2 - 29042031
AN - SCOPUS:85031321406
SN - 0002-9149
VL - 120
SP - 2031
EP - 2034
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 11
ER -