title: Global left ventricular load in asymptomatic aortic stenosis: covariates and prognostic implication (the SEAS trial).
abstract: BACKGROUND
  Valvuloarterial impedance (Zva) is a measure of global (combined valvular and arterial) load opposing left ventricular (LV) ejection in aortic stenosis (AS). The present study identified covariates and tested the prognostic significance of global LV load in patients with asymptomatic AS.
  
  
  METHODS
  1418 patients with mild-moderate, asymptomatic AS in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study were followed for a mean of 43±14 months during randomized, placebo-controlled treatment with combined simvastatin 40 mg and ezetimibe 10 mg daily. High global LV load was defined as Zva >5 mm Hg/ml/m2. The impact of baseline global LV load on rate of major cardiovascular (CV) events, aortic valve events and total mortality was assessed in Cox regression models reporting hazard ratio (HR) and 95% Confidence Intervals (CI).
  
  
  RESULTS
  High global LV load was found in 18% (n=252) of patients and associated with female gender, higher age, hypertension, more severe AS and lower ejection fraction (all p<0.05). A total of 476 major CV events, 444 aortic valve events and 132 deaths occurred during follow-up. In multivariate Cox regression analyses, high global LV load predicted higher rate of major CV events (HR 1.35 [95% CI 1.08-1.71], P=0.010) and aortic valve events (HR 1.41 [95% CI 1.12-1.79], P=0.004) independent of hypertension, LV ejection fraction, female gender, age, abnormal LV geometry and AS severity, but failed to predict mortality.
  
  
  CONCLUSIONS
  In asymptomatic AS, assessment of global LV load adds complementary information on prognosis to that provided by hypertension or established prognosticators like AS severity and LV ejection fraction.
authors.affiliation: Institute of Medicine, University of Bergen, Bergen, Norway. ashild.rieck@gmail.com
authors.forename: Ashild E
authors.initials: AE
authors.lastname: Rieck
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
authors.forename: Mai Tone
authors.initials: MT
authors.lastname: Lønnebakken
authors.forename: Edda
authors.initials: E
authors.lastname: Bahlmann
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Christa
authors.initials: C
authors.lastname: Gohlke-Bärwolf
authors.forename: Simon
authors.initials: S
authors.lastname: Ray
authors.forename: Dana
authors.initials: D
authors.lastname: Cramariuc
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D001384:Azetidines / Q000627:therapeutic use; D001794:Blood Pressure; D004311:Double-Blind Method; D000069438:Ezetimibe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D019821:Simvastatin; D000069438:Ezetimibe