Prognostic Value of E/E′ Ratio in Patients With Unoperated Severe Aortic Stenosis
Open accessAbstract
Objectives The aim of this study was to evaluate the value of clinical and echo-Doppler parameters for the prognosis of unoperated severe aortic stenosis (AS).Background Approximately one-third of severe, symptomatic AS patients are denied surgery. Risk stratification of unoperated AS is important to determine eligibility for percutaneous aortic valve replacement, an evolving treatment option for AS patients deemed suboptimal for surgical aortic valve replacement.Methods We retrospectively compared clinical and echo-Doppler parameters between survivors and nonsurvivors of 125 patients with unoperated severe AS.Results The 1-year survival rate was 62.4%. In univariate analysis, survivors compared with nonsurvivors were younger (80.0 ± 10.9 years vs. 84.9 ± 11.1 years, p = 0.02), had a greater left ventricular ejection fraction (LVEF) (55 ± 15% vs. 50 ± 16%, p = 0.042), a higher left ventricular stroke volume (63 ± 19 ml vs. 56 ± 13 ml, p = 0.015), a lower E/E' ratio (12.19 ± 5.7 vs. 16.87 ± 7.43, p < 0.001), and a lower prevalence of E/E' > 15 (20% vs. 55%, p < 0.001). Symptomatic status was nonsignificantly different between survivors and nonsurvivors. In patients with an LVEF ≥ 50%, the subgroup with E/E' ≤ 15 and with E/E' > 15 had a 73.8% and 47.8% 1-year survival rate, respectively (p = 0.027). In the patients with an LVEF < 50%, the patients with E/E' ≤ 15 and those with E/E' > 15 demonstrated a 70.6% and 22.3% 1-year survival rate, respectively (p = 0.003). In multivariate analysis, significant predictors of mortality were E/E' > 15 and a combination of E/E' > 15 and B-type natriuretic peptide > 300 ng/ml: adjusted mortality risk 2.34 (95% confidence interval (CI) 1.27 to 4.33, p = 0.0072) and 2.59 (95% CI 1.21 to 5.55, p = 0.014), respectively.Conclusions The E/E' ratio is the single most predictive clinical and echo-Doppler parameter in the assessment of overall prognosis in patients with unoperated severe AS. LVEF was a significant predictor of survival only in the univariate analysis. B-type natriuretic peptide alone was not a predictor of prognosis in the study population. However, the combination of E/E' and B-type natriuretic peptide is even more predictive of the 1-year prognosis.
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The LV response to chronic pressure overload from aortic stenosis is characterized by hypertrophic remodelling with myocyte hypertrophy and fibrosis, and by diastolic and systolic dysfunction.
“The LV response to chronic pressure overload from AS is characterized by hypertrophic remodelling (myocyte hypertrophy and fibrosis) and diastolic and systolic dysfunction.”
From Calcific aortic stenosis (2016) · cites this paper as [260]
The Discussion (page not provided) says severe aortic stenosis causes systolic pressure overload and LV wall hypertrophy, and describes diastolic dysfunction alongside cases of depressed systolic function. It does not specify myocyte hypertrophy or fibrosis as components of that remodelling, so those details are unsupported by our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThis LV response considerably influences the morbidity and mortality of aortic stenosis.
“In many ways, this LV response considerably influences the morbidity and mortality of the disease199;257–260.”
From Calcific aortic stenosis (2016) · cites this paper as [260]
The Discussion (page not provided) describes LV hypertrophy and diastolic dysfunction in severe aortic stenosis and reports that an elevated E/E′ ratio marks patients at high risk of one-year mortality. This supports a link between the LV response and mortality, but the paper does not establish that the response causes worse outcomes or assess its effect on morbidity. (LLM, conf=0.84)
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References 47 · Cited by 63
Research works printed but not linked: 3
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- Authors
- Biner, S., Rafique, A. M., Goykhman, P., Morrissey, R. P., Naghi, J., & Siegel, R. J.
- Affiliations
- Cedars-Sinai Medical Center (US)
- Corresponding author
- Siegel, Robert J.
- Venue
- JACC: Cardiovascular Imaging
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 3
- Issue
- 9
- Pages
- 899-907
- ISSN
- 1876-7591 (ISSN-L)
- 1936-878X
- OpenAlex
- W2013354092
- Cited by
- 63
- References
- 47
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 2 · 2022: 7 · 2021: 2 · 2020: 4 · 2019: 6 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 6 · 2014: 4 · 2013: 4 · 2012: 4
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Cardiovascular imaging (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- severe aortic stenosis, E/e' ratio, prognosis, mortality prediction, left ventricular filling pressure, left ventricular ejection fraction, brain natriuretic peptide, risk stratification, percutaneous aortic valve replacement, one-year survival, left ventricular stroke volume, left ventricular hypertrophy, left atrial enlargement
- MeSH terms
- Aged, Aged, 80 and over, Aortic Valve Stenosis, Blood Pressure, Female, Humans, Male, Prognosis, Pulmonary Artery, Retrospective Studies, ROC Curve, Severity of Illness Index, Stroke Volume, Echocardiography, Doppler, Multivariate Analysis, Treatment Outcome, Risk Assessment, Natriuretic Peptide, Brain
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