Breaking News
October 22, 2018 - A stage IV cancer patient discusses what it means to live well with serious illness
October 22, 2018 - In Kids with Autism, Short Questionnaire May Detect GI Disorders
October 22, 2018 - Merck presents MK-1454 Phase 1 data for treatment of advanced solid tumors or lymphomas
October 22, 2018 - Aspirin may be effective in preventing blood clots after knee replacement
October 22, 2018 - Gilead Sciences presents Phase 3 results of filgotinib in biologic-experienced rheumatoid arthritis at 2018 ACR/ARHP Annual Meeting
October 22, 2018 - Immunotherapy with pembrolizumab extends survival in metastatic or recurrent head and neck cancer
October 22, 2018 - Health Tip: Keep Ticks Away
October 22, 2018 - Obsessive-compulsive disorder – Genetics Home Reference
October 22, 2018 - Researchers find disrupted functional connectivity in cerebellum of adults with HF-ASD
October 22, 2018 - Deciphera presents Phase 1 clinical results of DCC-2618 in patients with gastrointestinal stromal tumors
October 22, 2018 - Combination of Opdivo and Yervoy shows four-year survival benefits in patients with advanced melanoma
October 22, 2018 - Overcoming bottlenecks in early drug discovery with the power of sound
October 22, 2018 - Scientists discover genes that contribute to ADHD development
October 22, 2018 - Incyte announces Phase 2 FIGHT-202 trial data in patients with cholangiocarcinoma
October 22, 2018 - FDA approves update to Rituxan label to include information on treatment of rare forms of vasculitis
October 22, 2018 - At-home biofeedback therapy effective in relieving difficult-to-treat constipation
October 22, 2018 - Merck presents KEYNOTE-057 trial results for patients with high-risk non-muscle invasive bladder cancer
October 22, 2018 - People with periodontal disease less likely to reach healthy blood pressure ranges
October 22, 2018 - Phase III LONSURF study shows progression-free survival in patients with refractory metastatic gastric cancer
October 22, 2018 - Primary care doctors ‘not doing enough’ to curb STDs
October 22, 2018 - Pfizer announces PALOMA-3 trial results in patients with HR+, HER2- metastatic breast cancer
October 22, 2018 - ImmunoGen announces study results of platinum-resistant ovarian cancer therapy at ESMO 2018 Congress
October 22, 2018 - Study findings could set new standard of care for advanced anal cancer
October 22, 2018 - Erlotinib improves progression-free survival in EGFR mutated NSCLC
October 22, 2018 - Pain, insomnia, and depression often drive osteoarthritis patients to seek medical care
October 22, 2018 - The International Society of Refractive Surgery honors Vivior Chairman with Casebeer Award
October 22, 2018 - Multi-strain probiotic helps reduce chemotherapy-induced diarrhea in cancer patients
October 22, 2018 - Study shows potential of avelumab plus axitinib as new treatment option for patients with advanced RCC
October 22, 2018 - Vertex gets European CHMP positive opinion for KALYDECO to treat patients with cystic fibrosis
October 22, 2018 - Phase III trial reports positive results with HDAC inhibitor in advanced breast cancer patients
October 22, 2018 - Prostate radiotherapy improves survival in men with low burden of metastatic disease
October 22, 2018 - Duration of respiratory disturbances may better predict mortality risk from OSA
October 22, 2018 - Free phone app helps low-income obese patients to lose weight
October 22, 2018 - Immunotherapy with nivolumab and ipilimumab may improve survival in patients with MSI-high metastatic colorectal cancers
October 22, 2018 - FOTIVDA expected to be included in new ESMO guidelines for advanced renal cell carcinoma
October 22, 2018 - Compression Collar May Protect Brain of Female Soccer Players
October 22, 2018 - Technique visualizes neuron communication
October 22, 2018 - Advancement in medical imaging methods for health care
October 22, 2018 - Takeda presents vedolizumab phase 3 VISIBLE 1 trial results for treatment of moderately to severely active ulcerative colitis
October 22, 2018 - Immunotherapy increases survival in some patients with metastatic triple negative breast cancer
October 22, 2018 - Exelixis presents CABOSUN and METEOR trial results in patients with advanced renal cell carcinoma
October 22, 2018 - LYNPARZA Phase III SOLO-1 results show improved outcome for patients with advanced BRCA-mutated ovarian cancer
October 22, 2018 - Brainlab unveils ExacTrac Dynamic at ASTRO meeting in San Antonio, Texas
October 22, 2018 - Not exercising is worse than smoking, diabetes or heart disease finds study
October 22, 2018 - Shorter course of trastuzumab could be an option for women with HER2+ early breast cancer
October 22, 2018 - Map of Mouse Hippocampus Could Be Weapon Against Alzheimer’s
October 22, 2018 - Psychotropic polypharmacy is common in Alzheimer’s disease
October 22, 2018 - Texas A&M and UTA establish Texas Genomics Core Alliance
October 22, 2018 - Analyzing mouse’s potential as animal model of decision-making
October 22, 2018 - Radiotherapy can prolong survival in prostate cancer
October 22, 2018 - A genetic mutation involved in relapse
October 21, 2018 - Report reveals growing impact of cannabis on young people
October 21, 2018 - NSF awards $5 million grant to help scientists magnify societal impact of research
October 21, 2018 - Fertility Rates Down for Each Urbanization Level 2007 to 2017
October 21, 2018 - Genetically engineered 3-D human muscle transplant in a murine model
October 21, 2018 - Moms’ tight work schedules may affect their children’s sleep
October 21, 2018 - AHA: No Direct Link Between Preeclampsia and Cognitive Impairment, Study Finds
October 21, 2018 - Weight loss success linked with active self-control regions of the brain
October 21, 2018 - Scripps researchers successfully test potential new smoking-cessation treatment in rodents
October 21, 2018 - More accurate and less stressful way to measure a baby’s heartbeat
October 21, 2018 - Researchers show better cardiorespiratory fitness leads to longer life
October 21, 2018 - Healthy candies for diabetic patients
October 21, 2018 - Environment impact of microplastics remains unclear
October 21, 2018 - Antibiotics for appendicitis? Surgery often not needed
October 21, 2018 - AHA and AMA recognize more than 800 medical practices, health systems for blood pressure control
October 21, 2018 - Scientists obtain clearest ever image of Ebola virus protein
October 21, 2018 - Study reveals connection between two proteins known to be hyperactive in cancer
October 21, 2018 - Gabapentin Beats Pregabalin for Chronic Sciatica
October 21, 2018 - Cosmetic surgeons offering incomplete information for breast augmentation customers
October 21, 2018 - Chronic sleep disruption in early adult life accelerates AD-related tau pathology
October 21, 2018 - Take 10 for Mindfulness – Drugs.com MedNews
October 21, 2018 - Length of breathing disruption in OSA may be better predictor of mortality risk
October 21, 2018 - ApoE4 gene linked with chronic inflammation increases risk for Alzheimer’s disease
October 21, 2018 - Mother-daughter conflict associated with suicide risk in abused adolescent girls
October 21, 2018 - Scientists molding bacteria into unnatural shapes
October 21, 2018 - High diet quality associated with lower risk of death in colorectal cancer patients
October 21, 2018 - Discharged mental health patients ‘at greater risk of dying’
October 21, 2018 - Research provides insight into neurobiology of aggression and bullying
October 21, 2018 - As billions in tax dollars flow to private Medicaid plans, Who’s minding the store?
October 21, 2018 - Neuroscientists identify brain region that appears to be related to food preference decisions
‘Normal’ LVEF: Misnomer in Aortic Stenosis?

‘Normal’ LVEF: Misnomer in Aortic Stenosis?

image_pdfDownload PDFimage_print

Some people with severe aortic stenosis may be at higher risk for events if they wait to get an aortic valve replacement — even if their left ventricular ejection fraction (LVEF) measures are in the normal range, a registry study suggested.

Among those whose aortic stenosis was managed conservatively, according to the Japanese CURRENT AS registry, combined aortic valve-related deaths and heart failure hospitalizations were more common in patients with lower LVEF (72.3% for LVEF <50%, 58.4% for LVEF 50-59%, 38.7% for LVEF 60-69%, and 35.0% for LVEF ≥70%, P<0.001). On adjustment, the groups associated with worse outcomes were LVEF <50% (HR 1.82, 95% CI 1.44-2.28) and LVEF 50-59% (HR 1.77, 95% CI 1.42-2.20) in comparison with LVEF ≥70%.

Patients who did get initial valve replacement had rates of the combined endpoint still favoring higher LVEF, perhaps not with such marked difference (20.2%, 20.3%, 17.7%, 12.3%, P=0.03). Taking into account several confounders, there was no longer any difference among the four groups, according to Takeshi Kimura, MD, of Kyoto University Graduate School of Medicine in Japan, and colleagues.

“Our study demonstrates that survival in severe aortic stenosis is impaired when LVEF is <60%, and these findings have implications for decision-making with regards to timing of surgical intervention," they wrote in JACC: Cardiovascular Interventions.

In an accompanying editorial, James McCabe, MD, of University of Washington Medical Center in Seattle, took it one step further and suggested that “perhaps the floor for ‘normal’ LVEF in the setting of aortic stenosis has been set too low.”

“Current American guidelines recommend aortic valve replacement for patients who have severe, high-gradient aortic stenosis and either: symptoms attributable to aortic stenosis or left ventricular dysfunction, defined as an LVEF < 50%."

The question is whether that second requirement is really necessary for patients with hemodynamically severe aortic stenosis to get upfront aortic valve replacement. “In light of these provocative observational data and radical secular changes in the treatment [of] aortic stenosis over the last decade, the space is ripe for more definitive data,” McCabe said, citing the ongoing EARLY TAVR trial, which is a study randomizing asymptomatic patients with severe aortic stenosis, an LVEF >50% and a negative exercise stress test to early transcatheter aortic valve replacement or conservative management.

The CURRENT AS registry enrolled 3,815 consecutive patients in Japan with severe aortic stenosis, 21 of whom were excluded from the analysis for having insufficient LVEF measurements.

Index echocardiography divided the cohort into four LVEF groups with no core lab adjudication, Kimura’s group acknowledged. Additionally, LVEF was acquired by the Teichholz method — not currently recommended in the guidelines — and not remeasured over time.

McCabe pointed out how few patients underwent prompt surgical aortic valve replacement in this study.

“A total of 1,090 patients (29% of the registry population) had symptomatic, severe aortic stenosis at the time of enrollment (a Class I indication for valve replacement) but were conservatively managed originally, and ultimately only 46% of the total registry population ever received aortic valve replacement over a median of ~3.5 years of follow up,” according to the editorialist, who suggested that significant unmeasured risks existed within this specific population, ultimately limiting the generalizability of the present data.

The study was funded by a grant from Japan’s Research Institute for Production Development.

Kimura disclosed no relevant relationships with industry.

McCabe disclosed relevant relationships with Edwards Lifesciences and Boston Scientific.

2017-12-27T14:00:00-0500

Tagged with:

About author

Related Articles