Objectives In hypertension, low myocardial energetic efficiency (MEEi) has been documented as an integrated marker of metabolic and left ventricular (LV) myocardial dysfunction. We tested the predictive performance of MEEi in initially asymptomatic aortic stenosis (AS) patients free from diabetes and known cardiovascular disease. Methods Data from 1703 patients with mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study followed for 4.3 years was used. MEE was calculated from Doppler stroke volume/([heart rate/60]) and indexed to LV mass (MEEi). The threshold value for MEEi associated with increased mortality was identified in generalised additive model with smoothing splines. Covariables of MEEi were identified in logistic regression analysis. Outcome was assessed in Cox regression analysis and reported as HR and 95% CI. Results MEEi <0.34 mL/s per gram was associated with increased cardiovascular mortality (n=80) (HR 2.53 (95% CI 1.50 to 4.28)) and all-cause mortality (n=155) (HR 1.74 (95% CI 1.20 to 2.52)) (both p<0.01). The association was independent of confounders of low MEEI (<0.34 mL/s per gram) identified in multivariable logistic regression analysis, including more severe AS, higher body mass index, lower LV midwall shortening and ejection fraction and presence of hypertension. Comparison of the Cox models with and without MEEi among the covariables demonstrated that MEEi significantly improved the prognostic yield (both p<0.01). Conclusions In patients with initially asymptomatic AS, low MEEi was associated with clustering of cardiometabolic risk factors, lower LV myocardial function and subsequent increased mortality during 4.3 years follow-up, independent of known prognosticators. Trial registration number [NCT00092677][1]. Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00092677&atom=%2Fopenhrt%2F8%2F2%2Fe001720.atom

中文翻译：

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低心肌能量效率与主动脉瓣狭窄死亡率增加有关

目标 在高血压中，低心肌能量效率 (MEEi) 已被证明是代谢和左心室 (LV) 心肌功能障碍的综合标志物。我们在没有糖尿病和已知心血管疾病的最初无症状主动脉瓣狭窄 (AS) 患者中测试了 MEEi 的预测性能。方法 使用了 1703 名中度 AS 患者的数据，这些患者参加了辛伐他汀和依折麦布主动脉瓣狭窄研究，随访了 4.3 年。MEE 是根据多普勒每搏输出量/([心率/60]) 计算的，并以 LV 质量 (MEEi) 为索引。在具有平滑样条的广义加性模型中确定了与死亡率增加相关的 MEEi 阈值。在逻辑回归分析中确定了 MEEi 的协变量。结果在 Cox 回归分析中进行评估，并报告为 HR 和 95% CI。结果 MEEi <0.34 mL/s/g 与心血管死亡率增加 (n=80) (HR 2.53 (95% CI 1.50 to 4.28)) 和全因死亡率 (n=155) (HR 1.74 (95% CI 1.20)到 2.52))（均 p<0.01）。该关联与多变量逻辑回归分析中确定的低 MEEI（<0.34 mL/s/g）的混杂因素无关，包括更严重的 AS、更高的体重指数、更低的 LV 中壁缩短和射血分数以及存在高血压。协变量中有和没有 MEEi 的 Cox 模型的比较表明，MEEi 显着提高了预后产量（均 p<0.01）。结论 在最初无症状的 AS 患者中，低 MEEi 与心脏代谢危险因素的聚集相关，在 4.3 年的随访期间，LV 心肌功能降低，随后死亡率增加，与已知的预后因素无关。试验注册号 [NCT00092677][1]。可应合理要求提供数据。与研究相关的所有数据都包含在文章中或作为补充信息上传。[1]：/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00092677&atom=%2Fopenhrt%2F8%2F2%2Fe001720.atom