Surgical aortic valve replacement in patients with reduced ejection fraction. Prevalence and follow-up.

INTRODUCTION: Limited information exists on the prevalence and outcomes of patients undergoing surgical aortic valve replacement (SAVR) for aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF). This study aims to describe the number of AS patients undergoing SAVR with LVEF less than 55 % and quantify LVEF improvement at follow-up. MATERIAL AND METHODS: We analyzed patients undergoing SAVR with LVEF less than 55 % and the number of patients that improved the LVEF at 6 months. We defined 'improved LVEF' as a 10 % increase of LVEF compared to baseline. RESULTS: Out of 685 patients, 11.4 % (n = 78) had SAVR with LVEF <55 %. The median pre-surgery LVEF was 45 % [IQR 37-51]. In-hospital mortality was 5.1 % (n = 4). Follow-up data for 69 patients showed 50.7 % (n = 35) had improved LVEF. CONCLUSIONS: In our cohort, 10 % of severe AS patients underwent SAVR with LVEF <55 %, with half showing LVEF improvement at follow-up.

Estimación de la «edad vascular» basada en el índice de masa corporal en una población en prevención primaria. Asociación con la aterosclerosis carotídea subclínica / Estimation of the ‘‘vascular age’’ based on body mass index in a population in primary prevention. Association with subclinical carotid atherosclerosis

Fundamentos y objetivos: Conocer la relación entre la «edad vascular» (EV) y el diagnóstico de aterosclerosis subclínica podría optimizar la estratificación de riesgo cardiovascular. Los objetivos de este estudio fueron: 1) conocer la EV en una población en prevención primaria, y 2) determinar la relación entre la EV y la presencia de placa aterosclerótica carotídea (PAC). Pacientes y método: Se calculó la EV basada en el índice de masa corporal (IMC), así como la diferencia entre la EV y la edad cronológica (Delta). Se investigó la presencia de PAC por ultrasonido y se analizó la asociación entre quintiles de EV y de Delta con la presencia de PAC. Se realizó un análisis ROC. Resultados: Se incluyeron 411 pacientes, con una edad media (DE) de 47 (10) años; un 54% eran varones. La EV y Delta medias fueron 55 (15) y 7 (9) años, respectivamente. El 75% de los pacientes presentó una EV mayor que la edad cronológica (50% 6 años). Los sujetos con PAC mostraron una EV significativamente mayor (media de 66 [11] frente a 50 [14] años, p < 0,0001) y un mayor Delta (media de 13 [9] frente a 5 [7] años, p < 0,0001) que los sujetos sin PAC. Se observó una asociación positiva entre quintiles de EV y Delta con la prevalencia de PAC. El área bajo la curva y el punto de corte óptimo de la EV para la detección de PAC fueron 0,813 y 60 años, respectivamente, y para Delta, 0,771 y 11 años, respectivamente. Conclusiones: La EV basada en el IMC podría constituir una sencilla herramienta para estimar la presencia de PAC y mejorar la estratificación del riesgo cardiovascular en sujetos en prevención primaria (AU)

Background and objectives: To know the relationship between ‘‘vascular age’’ (VA) and the diagnosis of subclinical atherosclerosis could improve cardiovascular risk stratification. Objectives: 1) to know the VA in a primary prevention population, and 2) to determine the relationship between VA and the presence of carotid atherosclerotic plaque (CAP). Patients and methods: We calculated VA based on body mass index (BMI). We obtained the difference between VA and chronological age (Delta). The screening of CAP was done by ultrasound. We analyzed the association between quintiles of VA and Delta with the presence of CAP. ROC analysis was performed. Results: In total, 411 patients were included (age 47 [10] years, 54% men). The VA and Delta were 55 (15) and 7 (9) years respectively. In 75% of the patients VA was higher than the chronological age (50% 6 years). Subjects with CAP had significantly higher VA (66 [11] versus 50 [14] years, P < .0001) and Delta (13 [9] versus 5 [7] years, P < .0001) than subjects without CAP. We observed a positive association of quintiles of VA and Delta with the prevalence of CAP. The area under de curve and the optimal cutoff point of VA for the detection of CAP were 0.813 and 60 years, respectively, and for Delta, 0,771 and 11 years, respectively. Conclusions: The VA based on BMI could be a simple tool to estimate the presence of CAP and improve cardiovascular risk stratification in patients in primary prevention (AU)