Higher cardiovascular risk in aortic stenosis with asymmetric interventricular septum hypertrophy

In his PhD thesis, Eigir Einarsen has analyzed echocardiographic images of nearly 2000 patients with aortic stenosis, aiming to identify new markers of cardiac function and prognosis.


MAIN RESULTS:

  1. Asymmetric interventricular septum hypertrophy is linked to major cardiovascular events in patients with moderate aortic stenosis.
  2. Persistent left ventricular hypertrophy after aortic valve replacement is far much more common in obese patients.
  3. First-phase ejection fraction is inversely associated with aortic stiffness in aortic stenosis.

THESIS DEFENCE:

Thesis: Cardiovascular risk markers in aortic valve stenosis
Candidate: Eigir Einarsen
Time: December 4, 2020 at 12:15
Place: Online-based solution, due to the covid-19 situation
Link to university website (in Norwegian)


SUMMARY:

(1) Persistent or new-onset asymmetric interventricular septum hypertrophy is independently linked to 45% increased risk of ischemic cardiovascular events in patients with initially asymptomatic, mostly moderate aortic stenosis. The risk was particularly increased for coronary artery bypass grafting. Mortality was not significantly higher than in patients without asymmetric interventricular septum hypertrophy

1,691 patients were included, of which 17% had persistent or new-onset asymmetric interventricular septum hypertrophy. They were followed for median 4.3 years.

(2) Obese patients have almost four-fold prevalence of persistent left ventricular hypertrophy after successful aortic valve replacement, compared to both normal weight and overweight patients. The association was independent of significant associations with higher systolic blood pressure and lower left ventricular midwall shortening before the procedure. Data from 399 patients were analysed in the study.

(3) Lower first-phase ejection fraction (volume change from end-diastole to the time that corresponded to peak aortic jet velocity) is linked to lower myocardial contractility (strain rate) and higher arterial stiffness (central pulse pressure/stroke volume index ratio) in patients with aortic stenosis. These associations are independent of aortic stenosis severity. The study includes 114 patients.


REFERENCES:

(1) Einarsen, E., Cramariuc, D., Lønnebakken, M. T., Boman, K., Gohlke-Bärwolf, C., Chambers, J. B., & Gerdts, E. (2017). Comparison of frequency of ischemic cardiovascular events in patients with aortic stenosis with versus without asymmetric septal hypertrophy (from the SEAS trial). The American Journal of Cardiology119(7), 1082-1087.

(2) Einarsen, E., Saeed, S., Cramariuc, D., Chambers, J. B., Midtbø, H., & Gerdts, E. (2019). Impact of Obesity on Persistent Left Ventricular Hypertrophy After Aortic Valve Replacement for Aortic Stenosis. The American journal of cardiology123(6), 942-947.

(3) Einarsen, E., Hjertaas, J., Gu, H., Matre, K., Chowienczyk, P. J., Gerdts, E., Chambers, J. B., & Saeed, S. (2020). Impact of arterio–ventricular interaction on first-phase ejection fraction in aortic stenosis. European Heart Journal. Cardiovascular Imaging

 

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