title: Comparison of Frequency of Ischemic Cardiovascular Events in Patients With Aortic Stenosis With Versus Without Asymmetric Septal Hypertrophy (from the SEAS Trial).
abstract: Asymmetric interventricular septum hypertrophy (ASH) has been associated with increased perioperative morbidity and mortality in patients with severe, symptomatic aortic valve stenosis (AS). Less is known about the prognostic impact of ASH during progression of AS. Clinical, echocardiographic, and outcome data from 1,691 patients with initially asymptomatic, mostly moderate AS, participating in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study was used. ASH was considered present if interventricular septum/posterior wall thickness ratio in end-diastole ≥1.5. The associations of ASH with hazard rate of ischemic cardiovascular events were tested in time-dependent Cox regression analyses. Based on the presence of ASH at study echocardiograms, the study population was grouped in to a no-ASH, nonpersistent ASH, persistent ASH, and new-onset ASH groups. During a median of 4.3 years of follow-up, ASH persisted or developed in 17% of patients. Persistent or new-onset ASH was characterized by higher left ventricular mass index and ejection fraction at baseline (both p <0.05) but not with female gender or hypertension. In time-varying Cox regression analyses adjusting for these confounders, persistent or new-onset ASH was associated with higher hazard rate of ischemic cardiovascular events (hazard rate 1.45; 95% confidence interval 1.09 to 1.91, p = 0.01), in particular coronary artery bypass grafting (hazard rate 1.69; 95% confidence interval 1.17 to 2.47; p = 0.006), whereas no association with increased mortality was found. In conclusion, in patients with AS without diabetes or known renal or cardiovascular disease participating in the SEAS study, persistent or new-onset ASH during progression of AS was associated with higher rate of ischemic cardiovascular events.
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway. Electronic address: eigir.einarsen@uib.no.
authors.forename: Eigir
authors.initials: E
authors.lastname: Einarsen
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Dana
authors.initials: D
authors.lastname: Cramariuc
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Mai T
authors.initials: MT
authors.lastname: Lønnebakken
authors.affiliation: Department of Public Health, University of Umeaa, Skelefteaa, Sweden.
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
authors.affiliation: Department of Cardiology, Herz-Zentrum Bad Krozingen, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Gohlke-Bärwolf
authors.affiliation: Cardiothoracic Centre, Guy's and St Thomas Hospitals, London, United Kingdom.
authors.forename: John B
authors.initials: JB
authors.lastname: Chambers
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D004311:Double-Blind Method; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies