Breaking News
August 18, 2018 - Immigrants Not a Burden on U.S. Health Care: Study
August 18, 2018 - Women who eat fast food take longer to become pregnant
August 18, 2018 - Most YouTube videos on plastic surgery are misleading marketing campaigns
August 18, 2018 - The essential guide to make your laboratory more sustainable
August 18, 2018 - Researchers describe promising strategy to remove melanoma’s most powerful defenses
August 18, 2018 - Women with polycystic ovary syndrome dissatisfied with medical care
August 18, 2018 - Research discoveries reveal insights behind neurological degeneration
August 18, 2018 - Researchers win multi-million Euro award to conduct research into liver disease
August 18, 2018 - Survey highlights variations in practice of airway management in pediatric intensive care units
August 18, 2018 - UK students win sponsorship from Promega Corporation
August 18, 2018 - Janssen Reports Positive Topline Results for ATLAS Phase III Study of a Novel, Long Acting Injectable Two-Drug Regimen for the treatment of HIV-1
August 18, 2018 - PSD as a molecular platform for understanding synapse formation and plasticity
August 18, 2018 - Improved visual communication could help patients to make informed health-care decisions
August 18, 2018 - New algorithm helps identify and manage diabetic patients at increased fracture risk
August 18, 2018 - Microscopic insect odour detecting mechanisms discovered
August 18, 2018 - Researchers develop new approach to study how tuberculosis infects people
August 18, 2018 - FDA Approves Kalydeco (ivacaftor) for Cystic Fibrosis in Children Ages 12 to
August 18, 2018 - An ion channel differentiates newborn and mature neurons in the adult brain
August 18, 2018 - Socio-economic position associated with pregnant women’s exposure to environmental hazards
August 18, 2018 - Voters to settle dispute over ambulance employee break times
August 18, 2018 - AGA urges policymakers and stakeholders to improve affordability of drugs
August 18, 2018 - Increasing dietary protein may lower risk of diabetes in people with NAFLD
August 18, 2018 - New HIV therapy suppresses viral replication and increases immune cells in drug-resistant patients
August 18, 2018 - Broad Genetic Testing for NSCLC May Not Improve Survival
August 18, 2018 - Discovery opens door for synthetic opioids with less addictive qualities
August 18, 2018 - Transgenic rice plant extracts could help stop the spread of HIV
August 18, 2018 - Hologic’s Cynosure division partners with Porter Instrument to distribute nitrous oxide and oxygen system
August 18, 2018 - Two thyroid medications recalled by FDA
August 18, 2018 - Forecast Sees Abnormal Heat Worldwide Through 2022
August 18, 2018 - Childhood absence epilepsy – Genetics Home Reference
August 18, 2018 - Fearing hard Brexit, UK drugmakers stockpile to protect lives
August 18, 2018 - Discovery may help broaden the scope of defenses against HPV
August 18, 2018 - When they start thinking green, they see green
August 18, 2018 - Scientists introduce microfluidics-based chip for manipulation and analysis of single cells
August 18, 2018 - Researchers design new way to grow nose cells for treating spinal cord injuries
August 18, 2018 - New light shed on relationship between calorie-burning fat and muscle function
August 18, 2018 - Surgery Saturday Instagram series takes you inside Stanford’s OR
August 18, 2018 - Researchers uncover surprising new role for inhibition in the cerebellum
August 18, 2018 - Children have better nutrition when they live near forests, global study shows
August 18, 2018 - OHSU professor conducts clinical trial with artificial pancreas using Xeris’ liquid glucagon
August 18, 2018 - HSS takes young patients with physical challenges on a surfing trip
August 18, 2018 - Study shows electronic health records leave doctors and patients unsatisfied
August 18, 2018 - Study uncovers mechanism that affects multiplication of dengue virus lineage
August 18, 2018 - UTHealth safety expert talks about preparing for the most destructive hurricanes
August 18, 2018 - Theravance Biopharma Reports Positive Top-Line Four-Week Data from Phase 2 Trial of TD-9855 for the Treatment of Symptomatic Neurogenic Orthostatic Hypotension
August 18, 2018 - Animations prove effective in accurately measuring pain
August 18, 2018 - Three faculty members appointed to endowed positions | News Center
August 18, 2018 - New technique detects, measures, analyzes unevenly charged biomolecules
August 18, 2018 - Brief exposures to stressors can be beneficial to cells, shows study
August 18, 2018 - UTHealth-led survey shows much work remains to increase safety of e-health records
August 18, 2018 - Researchers use super-resolution microscope to unravel secrets of deadly Nipah virus
August 18, 2018 - Scientists identify pathways that reveal insights into mechanism of lung cancer etiology
August 18, 2018 - Rush’s health care IT leaders reach White House
August 18, 2018 - FDA approves marketing of brainsway deep transcranial magnetic stimulation system for OCD
August 17, 2018 - OUHSC gets $20 million grant to advance research and patient care for Oklahomans
August 17, 2018 - Sperm morphology differs depending on qualities of male bird
August 17, 2018 - Texas A&M researchers develop clay-based platform to grow blood vessels
August 17, 2018 - FDA Approves Expanded Indication for Orkambi (lumacaftor/ivacaftor) in Children Ages 2-5 Years
August 17, 2018 - Caring for Concussions | NIH News in Health
August 17, 2018 - Team explores diabetes drug’s ability to treat RSV infection
August 17, 2018 - New imaging technique can spot tuberculosis infection in an hour | News Center
August 17, 2018 - PolyU researchers design new self-fitting scaffold to induce bone regeneration
August 17, 2018 - CartiHeal and LSU Health successfully enroll first two patients in Agili-C IDE pivotal study
August 17, 2018 - Less-invasive options are slowing disease progression in glaucoma patients
August 17, 2018 - Researchers discover new promising target point for cancer and diabetes therapies
August 17, 2018 - Podcast: KHN’s ‘What the Health?’ See you in court!
August 17, 2018 - New mobile phone application enables early detection of cerebral ictus
August 17, 2018 - AJMC addresses role of community pharmacies in boosting adult vaccination rates
August 17, 2018 - UK’s leading sight loss charity invites applications from brightest minds in ophthalmic research
August 17, 2018 - Alternative devices can help when autoinjectors are unavailable
August 17, 2018 - Researchers produce artificial placenta model that closely resembles natural organ
August 17, 2018 - Study offers possibility of squelching a focal epilepsy seizure before symptoms appear
August 17, 2018 - FDA Alert: Temporary Total Artificial Heart Companion 2 Driver System by SynCardia Systems: Letter to Health Care Providers
August 17, 2018 - New statewide program in North Dakota aims to stem opioid misuse
August 17, 2018 - Researchers discover why sepsis from a staph infection causes organ failure
August 17, 2018 - Stony Brook University’s new medical students start a transformative journey
August 17, 2018 - Revealed: The molecular mechanism underlying hypertrophic cardiomyopathy | News Center
August 17, 2018 - New modeling studies highlight urgent need for effective drug policy reforms to prevent HIV
August 17, 2018 - Research explores relationship between personal history of infectious fever and cancer risk
August 17, 2018 - Study finds rise in cases of progressive massive fibrosis among U.S. coal miners
‘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