1Universitätsklinikum Leipzig Klinik und Poliklinik für Kardiologie Leipzig, Deutschland
Background: A reduced global myocardial work index (GWI) ≤ 1951mmHg% is associated with increased mortality in patients with severe aortic valve stenosis (AS) (Ilardi et al., J Clin Med 2022). However, parameters for predictors of outcome in patients with moderate AS are limited. Therefore, the objective of the study was to evaluate the prognostic value of GWI in patients with moderate AS.
Methods and Results: In this prospective study 103 patients with moderate AS (mean age 72 ± 10 years; males: 69%) underwent standardized transthoracic echocardiography. The primary endpoint was survival without aortic valve replacement (AVR).
After a follow up period (median 30 ± 5 months), 37 patients (36%) were referred for AVR. Survival without AVR was 96% at 12 and 81% at 30months (> 1951mmHg%) vs. 92% and 64% (≤ 1951mmHg%). A GWI ≤ 1951mmHg% did not predict progression of moderate AS with respect to AVR (hazard ratio 1.31 [95% CI, 0.63-2.72], P = 0.49, Figure 1).
Further, there was no significant correlation between mean GWI (1644 mmHg% ± 448) and mean aortic valve pressure gradient (24.15mmHg ± 6.2, P = 0.615) or effective aortic orific area (1.24cm2 ± 0.11. P = 0.678). No association was found between GWI and clinical symptoms.
Conclusion: In contrast to patients with severe AS, a GWI ≤ 1951mmHg% did not predict progression of moderate AS. Further research is needed to improve risk stratification in patients with moderate AS.
Figure 1. Kaplan- Meier estimates for survival without aortic valve replacement (AVR) in moderate AS. A global myocardial work index ≤ 1951mmHg% and > 1951mmHg% was used as cut-off value.