Table 1.
Baseline characteristics.
| Characteristic |
Whole cohort (n = 1,211) |
LVEF ≤55% (n = 468) |
LVEF >55% (n = 743) |
P-value (≤55 vs. >55%) |
|---|---|---|---|---|
| Demographics and vital signs | ||||
| Age, yr [Median (IQR)] | 66 (57–73) | 67 (59–75) | 65 (56–72) | 0.009 |
| Male, no. (%) | 819 (67.6%) | 350 (74.8%) | 469 (63.1%) | <0.001 |
| BMI, kg/m2 [Median (IQR)] | 23.8 (21.5–26.1) | 23.7 (21.2–25.9) | 23.9 (21.7–26.2) | 0.098 |
| BSA, m2 (Mean ± SD) | 1.83 ± 0.19 | 1.82 ± 0.19 | 1.83 ± 0.18 | 0.379 |
| Heart rate, bpm [Median (IQR)] | 72 (65–81) | 75 (66–85) | 71 (64–80) | <0.001 |
| SBP, mmHg [Median (IQR)] | 130 (120–144) | 130 (119–144) | 130 (120–145) | 0.368 |
| DBP, mmHg [Median (IQR)] | 73 (65–80) | 71 (63–80) | 74 (66–80) | 0.049 |
| Risk factors and comorbidities | ||||
| Current Smoker, no. (%) | 234 (19.3%) | 107 (22.9%) | 127 (17.1%) | 0.014 |
| Hypertension, no. (%) | 719 (59.4%) | 271 (57.9%) | 448 (60.3%) | 0.410 |
| Diabetes, no. (%) | 153 (12.6%) | 63 (13.5%) | 90 (12.1%) | 0.493 |
| Dyslipidemia, no. (%) | 196 (16.2%) | 52 (11.1%) | 144 (19.4%) | <0.001 |
| Atrial fibrillation, no. (%) | 221 (18.2%) | 110 (23.5%) | 111 (14.9%) | <0.001 |
| Coronary artery disease, no. (%)* | 500 (41.3%) | 210 (44.9%) | 290 (39%) | 0.045 |
| Prior Myocardial infarction, no. (%) | 78 (6.4%) | 52 (11.1%) | 26 (3.5%) | <0.001 |
| Prior PCI, no. (%) | 166 (13.7%) | 75 (16.0%) | 91 (12.2%) | 0.065 |
| Prior CABG, no. (%) | 19 (1.6%) | 14 (3.0%) | 5 (0.7%) | 0.003 |
| Aortic disease, no. (%)† | 178 (14.7%) | 58 (12.4%) | 120 (16.2%) | 0.070 |
| Cerebrovascular disease, no. (%) | 134 (11.1%) | 52 (11.1%) | 82 (11.0%) | 0.968 |
| Peripheral artery disease, no. (%) | 53 (4.4%) | 12 (2.6%) | 41 (5.5%) | 0.011 |
| Chronic obstructive pulmonary disease, no. (%) | 74 (6.1%) | 40 (8.5%) | 34 (4.6%) | 0.006 |
| Chronic kidney disease, no. (%) | 72 (5.9%) | 42 (9.0%) | 30 (4.0%) | 0.001 |
| Baseline symptoms | ||||
| Dyspnea, no. (%) | 619 (51.1%) | 297 (63.5%) | 322 (43.3%) | <0.001 |
| Chest pain, no. (%) | 332 (27.4%) | 119 (25.4%) | 213 (28.7%) | 0.217 |
| NYHA functional classification, no. (%) | <0.001 | |||
| I | 560 (46.2%) | 148 (31.6%) | 412 (55.5%) | |
| II | 359 (29.6%) | 123 (26.3%) | 236 (31.8%) | |
| III | 217 (17.9%) | 141 (30.1%) | 76 (10.2%) | |
| IV | 75 (6.2%) | 56 (12%) | 19 (2.6%) | |
| Laboratory | ||||
| Hemoglobin, g/L [Median (IQR)] | 134 (121–146) | 133 (121–146) | 135 (122–147) | 0.293 |
| eGFR, ml/min/1.73 m2 (Mean ± SD) | 85.3 ± 26.8 | 79.8 ± 25.5 | 88.9 ± 27.0 | <0.001 |
| LDL, mmol/L [Median (IQR)] | 2.3 (1.8–2.9) | 2.3 (1.8–2.8) | 2.4 (1.9–3.0) | 0.007 |
| Total cholesterol, mmol/L [Median (IQR)] | 4.0 (3.3–4.7) | 3.9 (3.3–4.5) | 4.0 (3.4–4.8) | 0.002 |
| NT–proBNP (n = 595), pg/ml [Median (IQR)] | 539 (150–2105) | 1652 (444–4527) | 276 (98–733) | <0.001 |
| BNP (n = 177), pg/ml [Median (IQR)] | 49 (19–160) | 156 (52–321) | 28 (9–69) | <0.001 |
| Echocardiography | ||||
| LVEF, % [Median (IQR)] | 59 (52–64) | 45 (35–52) | 62 (60–65) | <0.001 |
| LVESD, mm [Median (IQR)] | 36 (31–42) | 44 (38–52) | 33 (30–36) | <0.001 |
| LVESD >50 mm [Median (IQR)] | 142 (11.7%) | 139 (29.7%) | 3 (0.4%) | <0.001 |
| LVESDi, mm/m2 [Median (IQR)]‡ | 19.5 (17.2–23.5) | 24.5 (20.6–28.7) | 17.9 (16.2–20.0) | <0.001 |
| LVEDD, mm [Median (IQR)] | 54 (49–60) | 60 (53–67) | 51 (47–56) | <0.001 |
| LVEDD >70 mm [Median (IQR)] | 78 (6.4%) | 74 (15.8%) | 4 (0.5%) | <0.001 |
| LVEDDi, mm/m2 [Median (IQR)]‡ | 29.8 (26.9–33.4) | 33.1 (29.6–36.9) | 28.4 (25.9–31.0) | <0.001 |
| LAi, mm/m2 [Median (IQR)]‡ | 21.7 (19.3–25.0) | 23.5 (20.9–27.5) | 20.7 (18.8–23.6) | <0.001 |
| Aortic valve morphology, no. (%) | 0.183 | |||
| Tricuspid | 1124 (92.8%) | 441 (94.2%) | 683 (91.9%) | |
| Bicuspid | 75 (6.2%) | 25 (5.3%) | 50 (6.7%) | |
| Unicuspid/Quadricuspid | 12 (1.0%) | 2 (0.4%) | 10 (1.3%) | |
| Moderate secondary MR, no. (%) | 159 (13.1%) | 111 (23.7%) | 48 (6.5%) | <0.001 |
| ≥moderate TR, no. (%) | 191 (15.8%) | 94 (20.1%) | 97 (13.1%) | 0.001 |
| Pulmonary hypertension, no. (%) | 236 (19.5%) | 125 (26.7%) | 111 (14.9%) | <0.001 |
| Ascending aortic diameter, mm | 36 (31–41) | 36 (32–41) | 36 (31–41) | 0.173 |
| >45 mm, no. (%) | 121 (10.1%) | 40 (8.5%) | 81 (10.9%) | 0.201 |
| Reasons for admission | 0.767 | |||
| Admitted for VHD§ | 398 (32.9%) | 150 (32.1%) | 248 (33.4%) | |
| Admitted for cardiovascular diseases other than VHD | 712 (58.8%) | 281 (60.0%) | 431 (58.0%) | |
| Admitted for non–cardiovascular diseases | 101 (8.3%) | 37 (7.9%) | 64 (8.6%) | |
| Etiology|| | <0.001 | |||
| Degenerative | 442 (36.5%) | 143 (30.6%) | 299 (40.2%) | |
| Secondary | 473 (39.1%) | 222 (47.4%) | 251 (33.8%) | |
| Rheumatic | 78 (6.4%) | 24 (5.1%) | 54 (7.3%) | |
| Congenital | 119 (9.8%) | 36 (7.7%) | 83 (11.2%) | |
| Autoimmune | 5 (0.4%) | 3 (0.6%) | 2 (0.3%) | |
| EuroSCORE–II [Median (IQR)] | 1.0 (0.7–1.9) | 1.4 (0.9–2.5) | 0.9 (0.6–1.4) | <0.001 |
| Intervention | 306 (25.3%) | 116 (24.8%) | 190 (25.6%) | 0.759 |
| Aortic valve repair, no. (%) | 15 (1.2%) | 6 (1.3%) | 9 (1.2%) | 0.914 |
| SAVR, no. (%) | 283 (23.4%) | 106 (22.6%) | 177 (23.8%) | 0.638 |
| TAVR, no. (%) | 8 (0.7%) | 4 (0.9%) | 4 (0.5%) | 0.514 |
| Concomitant cardiac or aortic surgery | 170 (14.0%) | 60 (12.8%) | 110 (14.8%) | 0.331 |
| CABG, no. (%) | 53 (4.4%) | 19 (4.1%) | 34 (4.6%) | 0.668 |
| Aortic surgery, no. (%) | 73 (6.0%) | 17 (3.6%) | 56 (7.5%) | 0.004 |
| Other cardiac surgery, no. (%) # | 81 (6.7%) | 35 (7.5%) | 46 (6.2%) | 0.385 |
| Medication use | ||||
| Beta–blocker, no. (%) | 777 (64.2%) | 327 (69.9%) | 450 (60.6%) | 0.001 |
| ACEI/ARB, no. (%) | 631 (52.1%) | 276 (59%) | 355 (47.8%) | <0.001 |
| ARNI, no. (%) | 23 (1.9%) | 20 (4.3%) | 3 (0.4%) | <0.001 |
| Diuretics, no. (%) | 744 (61.4%) | 367 (78.4%) | 377 (50.7%) | <0.001 |
| Digitalis, no. (%) | 293 (24.2%) | 159 (34%) | 134 (18%) | <0.001 |
| Warfarin, no. (%) | 455 (37.6%) | 176 (37.6%) | 279 (37.6%) | 0.984 |
| New oral anticoagulants, no. (%) | 82 (6.8%) | 40 (8.5%) | 42 (5.7%) | 0.054 |
| Antiplatelet agents, no. (%) | 666 (55.0%) | 270 (57.7%) | 396 (53.3%) | 0.134 |
ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor; BMI, body mass index; BNP, B-type natriuretic peptide; BSA, body surface area; CABG, coronary artery bypass grafting; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; EuroSCORE-II, European System for Cardiac Operative Risk Evaluation; IQR, interquartile range; LA, left atrium end-diastolic dimension; LDL, low-density lipoproteins; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic dimension; MR, mitral regurgitation; NT-proBNP, N-terminal pro-B-type natriuretic peptide; NYHA, New York Heart Association; PCI, percutaneous coronary intervention; SBP, systolic blood pressure; SAVR, surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement; TR, tricuspid regurgitation; VHD, valvular heart disease.
Including CAD, previous myocardial infarction, and history of PCI and CABG procedures. Myocardial infarction within 90 days has been excluded from the study population.
Including aortic aneurysms, atherosclerotic and inflammatory aortic disease, genetic diseases (e.g., Marfan syndrome), and congenital abnormalities. Acute aortic syndromes (including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer) and aortic rupture have been excluded from the study population.
Dimensions of left ventricle and left atrium indexed to body surface area.
indicating hospitalization for the diagnosis and treatment of valvular heart disease.
The etiologies of AR were defined based on echocardiographic findings in conjunction with clinical profiles and surgical findings (if available).
Including heart valve surgery other than aortic valve intervention, antiarrhythmic surgery and other open-heart surgery.