Association of non-severe aortic stenosis with left ventricular reverse remodeling and clinical outcomes after cardiac resynchronisation therapy
M Ishiyama, N Fujimoto, T Kitano, T Omori, K Moriwaki, E Sugiura, S Nakamori, T Kurita, K DohiAbstract
Background
The clinical impact of non-severe aortic stenosis (AS) on the response to cardiac resynchronization therapy (CRT) remains unclear. We investigated whether non-severe AS affects left ventricular (LV) reverse remodeling and long-term outcomes after CRT.
Methods
We retrospectively analyzed 181 consecutive patients with chronic heart failure (mean age 70 years; 76% male) who underwent CRT-P or CRT-D implantation at a single center. Patients were categorized into a non-severe aortic stenosis (AS) group (mild or moderate AS) and a no AS group without echocardiographic evidence of AS. The primary endpoint was a composite of all-cause death and heart failure hospitalization. Left ventricular reverse remodeling, defined as a ≥15% reduction in left ventricular end-systolic volume (LVESV) at 6 months after CRT implantation was evaluated as a secondary endpoint to explore potential mechanisms underlying clinical outcomes.
Results
Patients with non-severe AS were older and had a higher baseline LV ejection fraction than those without AS. LV ejection fraction significantly improved over time in both groups (time effect p<0.01), with a significant group–time interaction (p=0.03), while the overall group effect was not significant (p=0.27). Similarly, LVESV significantly decreased over time (time effect p<0.01), with a significant interaction effect (p=0.03) and no significant overall group effect (p=0.10).LV reverse remodeling occurred less frequently in the non-severe AS group (39% vs. 66%, p<0.05) (Figure1). In multivariable logistic regression analysis, non-severe AS was independently associated with a lower likelihood of LV reverse remodeling. During a median follow-up of 3.5 years, the cumulative incidence of the composite endpoint was significantly higher in the non-severe AS group (log-rank p<0.05) (Figure2). In multivariable Cox proportional hazards analysis, non-severe AS independently predicted adverse outcomes (hazard ratio 2.19, 95% CI 1.19–4.16; p=0.01).
Conclusions
Non-severe AS is associated with attenuated LV reverse remodeling and worse long-term outcomes after CRT. The presence of non-severe AS may represent an additional risk factor limiting CRT efficacy in patients with heart failure.Figure1 Figure2