Left Ventricular Contractility and Wall Stress in Patients With Aortic Stenosis With Preserved or Reduced Ejection Fraction

Abstract Objectives This study sought to determine the prevalence of reduced contractility and uncompensated wall stress in patients with aortic stenosis (AS) with preserved or reduced left ventricular ejection fraction (LVEF) and their impact on survival. Background LVEF in AS is determined not only by contractility but also by loading conditions. Methods Patients with first diagnosis (time 0) of severe AS (aortic valve area, [AVA]≤1 cm 2 ) with prior echo study (-3±1 years) were identified. Contractility was evaluated by plotting midwall fractional shortening (mFS) against circumferential end-systolic wall stress (cESS), stratified by LVEF of 60% at time 0. The temporal changes (from −3 years to time 0) and prognostic value of LVEF, contractility, and wall stress were assessed. Results Of 445 patients, 290 (65%) had LVEF ≥60% (median: 66% [interquartile range {IQR}: 63% to 69%]) and 155 patients (35%) had LVEF  2 (IQR: 1.13 to 1.43 cm 2 ) at −3 years and 0.90 cm 2 (IQR: 0.83 to 0.96 cm 2 ) at time 0. Decreased contractility was already present at −3 years (49 [17%] vs. 59 [38%]; LVEF ≥60% vs.  Conclusions In patients with severe AS, LVEF  2 .