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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Cardiovascular Ultrasound 1/2012

Global left ventricular load in asymptomatic aortic stenosis: covariates and prognostic implication (the SEAS trial)

Zeitschrift:
Cardiovascular Ultrasound > Ausgabe 1/2012
Autoren:
Åshild E Rieck, Eva Gerdts, Mai Tone Lønnebakken, Edda Bahlmann, Giovanni Cioffi, Christa Gohlke-Bärwolf, Simon Ray, Dana Cramariuc
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-7120-10-43) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

ÅER, EG and DC designed the study, participated in data collection, performed the statistical analysis and drafted the manuscript. EB participated in the data collection. EB MTL CGB GC and SR participated in revisions of the manuscript. All authors read and approved the final manuscript.

Abstract

Introduction

Valvuloarterial impedance (Zva) is a measure of global (combined valvular and arterial) load opposing left ventricular (LV) ejection in aortic stenosis (AS). The present study identified covariates and tested the prognostic significance of global LV load in patients with asymptomatic AS.

Methods

1418 patients with mild-moderate, asymptomatic AS in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study were followed for a mean of 43±14 months during randomized, placebo-controlled treatment with combined simvastatin 40 mg and ezetimibe 10 mg daily. High global LV load was defined as Zva >5 mm Hg/ml/m2. The impact of baseline global LV load on rate of major cardiovascular (CV) events, aortic valve events and total mortality was assessed in Cox regression models reporting hazard ratio (HR) and 95% Confidence Intervals (CI).

Results

High global LV load was found in 18% (n=252) of patients and associated with female gender, higher age, hypertension, more severe AS and lower ejection fraction (all p<0.05). A total of 476 major CV events, 444 aortic valve events and 132 deaths occurred during follow-up. In multivariate Cox regression analyses, high global LV load predicted higher rate of major CV events (HR 1.35 [95% CI 1.08-1.71], P=0.010) and aortic valve events (HR 1.41 [95% CI 1.12-1.79], P=0.004) independent of hypertension, LV ejection fraction, female gender, age, abnormal LV geometry and AS severity, but failed to predict mortality.

Conclusion

In asymptomatic AS, assessment of global LV load adds complementary information on prognosis to that provided by hypertension or established prognosticators like AS severity and LV ejection fraction.
Zusatzmaterial
Authors’ original file for figure 1
12947_2012_446_MOESM1_ESM.pdf
Authors’ original file for figure 2
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Authors’ original file for figure 3
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Authors’ original file for figure 4
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Authors’ original file for figure 5
12947_2012_446_MOESM5_ESM.pdf
Literatur
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