OBJECTIVES The aim of this study was to investigate the prognostic impact of the decline in left ventricular ejection fraction (LVEF) at 1-year follow-up in patients with severe aortic stenosis (AS) managed conservatively. BACKGROUND No previous study has explored the association between LVEF decline during follow-up and clinical outcomes in patients with severe AS. METHODS Among 3,815 patients with severe AS enrolled in the multicenter CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry in Japan, 839 conservatively managed patients who underwent echocardiography at 1-year follow-up were analyzed. The primary outcome measure was a composite of AS-related deaths and hospitalization for heart failure. RESULTS There were 91 patients (10.8%) with >10% declines in LVEF and 748 patients (89.2%) without declines. Left ventricular dimensions and the prevalence of valve regurgitation and atrial fibrillation or flutter significantly increased in the group with declines in LVEF. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the group with declines in LVEF than in the group with no decline (39.5% vs. 26.5%; p < 0.001). After adjusting for confounders, the excess risk of decline in LVEF over no decline for the primary outcome measure remained significant (hazard ratio: 1.98; 95% confidence interval: 1.29 to 3.06). When stratified by LVEF at index echocardiography (≥70%, 60% to 69%, and <60%), the risk of decline in LVEF on the primary outcome was consistently seen in all the subgroups, without any interaction (p = 0.77). CONCLUSIONS Patients with severe AS with >10% declines in LVEF at 1 year after diagnosis had worse AS-related clinical outcomes than those without declines in LVEF under conservative management. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140).

中文翻译：

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重度主动脉瓣狭窄患者随访期间左心室射血分数下降。

目的本研究的目的是研究保守治疗的严重主动脉瓣狭窄（AS）患者在随访1年后左心室射血分数（LVEF）下降对预后的影响。背景技术先前的研究尚未探讨严重AS患者的随访期间LVEF下降与临床结局之间的关系。方法在日本登记的3,815例重度AS患者中，对多中心CURRENT AS（重度主动脉瓣狭窄患者的手术和药物治疗后的近期结果）登记进行了分析，分析了839名在1年随访中接受超声心动图检查的保守治疗患者。主要结果指标是与AS相关的死亡和心力衰竭住院的综合结果。结果有91例（10.8％）的患者> LVEF下降10％，748例患者（89.2％）没有下降。左室射血分数和瓣膜返流和心房纤颤或扑动的患病率随着LVEF下降而显着增加。LVEF下降组的主要结局指标累积3年发生率明显高于未下降组（39.5％vs. 26.5％； p <0.001）。在对混杂因素进行调整后，主要结局指标中LVEF下降而不是不下降的过度风险仍然很显着（危险比：1.98； 95％置信区间：1.29至3.06）。当在超声心动图上通过LVEF进行分层（≥70％，60％至69％和<60％）时，在所有亚组中均一致观察到LVEF下降的主要结果，没有任何相互作用（p = 0.77） 。结论在诊断后1年内，严重AS患者的LVEF下降> 10％的患者，其AS相关的临床结局要比在保守治疗下LVEF没有下降的患者更差。（患有严重主动脉狭窄注册处的患者接受外科手术和药物治疗后的同期结果； UMIN000012140）。