Abstract 14546: Left Ventricular Sphericity Index as a Predictor of Appropriate Implantable Cardioverter-defibrillator Therapy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rahul Myadam ◽  
Jason D'Souza ◽  
Kensey Gosch ◽  
Daniel Steinhaus
Keyword(s):  
Primary Prevention ◽  
Proportional Hazards ◽  
Wall Stress ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
P Value ◽  
Inappropriate Therapy ◽  
Sphericity Index ◽  
All Cause Mortality ◽  
Appropriate Therapy

Introduction: We assessed the hypothesis that markers of LV wall stress, such as LV sphericity index (SI), may predict appropriate therapy for ventricular arrhythmias (VA) in patients with primary prevention defibrillators, independent of LV ejection fraction. Methods: We performed a retrospective analysis of consecutive patients with new ICD or CRT-D placement for primary prevention at a single hospital from 01/01/2015 to 06/30/2018. TTE images were used for calculating LV SI, which was defined as the ratio of bi-plane LV end-diastolic volume to the volume of a hypothetical sphere with a diameter of LV end-diastolic length in apical 4-chamber view. Device interrogations were reviewed for appropriate therapy for VA and inappropriate therapy for non-VAs. Kaplan-Meier curves stratified by LV SI tertile were constructed, and Cox proportional hazards models were used to evaluate time to appropriate and inappropriate therapy, and all-cause mortality. Results: A total of 282 patients (ICD 154, CRT-D 128) were included. Baseline characteristics are described in the Table. We found a trend towards increased appropriate therapy as LV SI increased in the ICD but not the CRT-D group, but this was non-significant in both (ICD log-rank 0.63, p-value 0.73; CRT-D log-rank 0.07, p-value 0.96). There was no correlation between LV SI and time to all-cause mortality in the ICD (log-rank 0.53, p-value 0.76) or the CRT-D patients (log-rank 0.51, p-value 0.77). LV SI correlated significantly with time to inappropriate therapy in the ICD (log-rank 8.6, p-value 0.01), but not the CRT-D patients (log-rank 2.4, p-value 0.3). Conclusions: LV SI demonstrated a non-significant trend towards increased appropriate device therapy in the ICD but not the CRT-D group. LV SI predicted inappropriate therapy in the ICD but not the CRT-D group. Study power was limited by lower than expected event rates, possibly due to changes in device programming and improvements in heart failure therapies over time.

scholarly journals Smokeless tobacco, snus, at admission for percutaneous coronary intervention and future risk for cardiac events

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001109
Author(s):  
Ole Frobert ◽  
Christian Reitan ◽  
Dorothy K Hatsukami ◽  
John Pernow ◽  
Elmir Omerovic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Percutaneous Coronary Intervention ◽  
Smokeless Tobacco ◽  
Proportional Hazards ◽  
Coronary Intervention ◽  
Cox Proportional Hazards ◽  
P Value ◽  
Cardiac Events ◽  
Percutaneous Coronary ◽  
All Cause Mortality

ObjectiveTo assess the risk of future death and cardiac events following percutaneous coronary intervention (PCI) in patients using smokeless tobacco, snus, compared with patients not using snus at admission for a first PCI.MethodsThe Swedish Coronary Angiography and Angioplasty Registry is a prospective registry on coronary diagnostic procedures and interventions. A total of 74 958 patients admitted for a first PCI were enrolled between 2009 and 2018, 6790 snus users and 68 168 not using snus. We used Cox proportional hazards regression for statistical modelling on imputed datasets as well as complete-case datasets.ResultsPatients using snus were younger (mean (SD) age 61.0 (±10.2) years) than patients not using snus (67.6 (±11.1), p<0.001) and more often male (95.4% vs 67.4%, p<0.001). After multivariable adjustment, snus use was not associated with the primary composite outcome of all-cause mortality, new coronary revascularisation or new hospitalisation for heart failure at 1 year (HR 0.98, 95% CI 0.91 to 1.05). In patients using snus at baseline who underwent a second PCI (n=1443), the duration from the index intervention was shorter for subjects who continued using snus (n=921, 63.8%) compared with subjects who had stopped (mean number of days 285 vs 406, p value=0.001).ConclusionsSnus use at admission for a first PCI was not associated with a higher occurrence of all-cause mortality, new revascularisation or heart failure hospitalisation. Discontinuing snus after a first PCI was associated with a significantly longer duration to a subsequent PCI.

scholarly journals Effectiveness of Statins as Primary Prevention in People With Gout: A Population-Based Cohort Study

2019 ◽  
Vol 24 (6) ◽  
pp. 542-550
Author(s):  
Maria Garcia-Gil ◽  
Marc Comas-Cufí ◽  
Rafel Ramos ◽  
Ruth Martí ◽  
Lia Alves-Cabratosa ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Primary Prevention ◽  
Statin Therapy ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Research Quality ◽  
All Cause Mortality ◽  
Clinically Significant

Background: Cardiovascular guidelines do not give firm recommendations on statin therapy in patients with gout because evidence is lacking. Aim: To analyze the effectiveness of statin therapy in primary prevention of coronary heart disease (CHD), ischemic stroke (IS), and all-cause mortality in a population with gout. Methods: A retrospective cohort study (July 2006 to December 2017) based on Information System for the Development of Research in Primary Care (SIDIAPQ), a research-quality database of electronic medical records, included primary care patients (aged 35-85 years) without previous cardiovascular disease (CVD). Participants were categorized as nonusers or new users of statins (defined as receiving statins for the first time during the study period). Index date was first statin invoicing for new users and randomly assigned to nonusers. The groups were compared for the incidence of CHD, IS, and all-cause mortality, using Cox proportional hazards modeling adjusted for propensity score. Results: Between July 2006 and December 2008, 8018 individuals were included; 736 (9.1%) were new users of statins. Median follow-up was 9.8 years. Crude incidence of CHD was 8.16 (95% confidence interval [CI]: 6.25-10.65) and 6.56 (95% CI: 5.85-7.36) events per 1000 person-years in new users and nonusers, respectively. Hazard ratios were 0.84 (95% CI: 0.60-1.19) for CHD, 0.68 (0.44-1.05) for IS, and 0.87 (0.67-1.12) for all-cause mortality. Hazard for diabetes was 1.27 (0.99-1.63). Conclusions: Statin therapy was not associated with a clinically significant decrease in CHD. Despite higher risk of CVD in gout populations compared to general population, patients with gout from a primary prevention population with a low-to-intermediate incidence of CHD should be evaluated according to their cardiovascular risk assessment, lifestyle recommendations, and preferences, in line with recent European League Against Rheumatism recommendations.

FC 080VARIABILITY IN SERUM PHOSPHATE ASSESSED BY DIRECTIONAL CHANGE IS ASSOCIATED WITH INCREASED MORTALITY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Xiaoling (Janice) Ye ◽  
Karlien Ter Meulen ◽  
Len A Usvyat ◽  
Frank Van Der Sande ◽  
Constantijn Konings ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Smoothing Splines ◽  
Cox Proportional Hazards ◽  
Serum Phosphate ◽  
P Value ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Directional Change ◽  
Wide Variability

Abstract Background and Aims Prior studies showed that there is a wide variability between serial pre-dialysis measurements of serum phosphate (P). Serum P vary can be due to changes in nutritional intake, underlying bone disorders, medication use or inflammation. Various variability markers have been investigated to study the association between P variability and its association with outcomes, however, the directional trends have not been studied in depth. We aimed to study directional changes and investigated its association with outcomes. Method All adult incident HD patients treated in Fresenius Medical Care North America (FMCNA) clinics between 01/2010 and 10/2018 were included in this retrospective cohort study. Serum P levels were averaged from month 1 to 6 after the initiation of dialysis (baseline). Baseline absolute and directional range (DR) of serum P were calculated. DR of P was calculated as: P min/max (t2) – P max/min (t1), with P (t1) and P (t2) represents the timepoint when either the min P value or max P value was measured, whichever comes first, and with t2 happened after t1. It is positive when the minimum antedates the maximum, otherwise negative. All-cause mortality was recorded between months 7 and 18. Cox proportional hazards models with spline terms were applied to explore the association between absolute and DR of P and all-cause mortality. Additionally, tensor product smoothing splines were computed to study the interactions of P with absolute P and DR of P and their joint associations with outcomes, respectably. Results We studied 353,142 patients. The average age was 62.7 years, 58% were male, 64% were diabetic. Baseline P was 4.98 mg/dL, median absolute range was 2.40 mg/dL, median DR was 1.1 mg/dL. Across different levels of P, both higher levels of absolute range and DR of P were associated with higher risk of mortality (Figure 1, Figure 2). The associations even seemed stronger in patients with lower levels of serum P and with negative DR (Figure 1). Conclusion Lower levels of serum P are independently associated with an increased risk of all-cause mortality. Whereas both a positive and negative DR of P are in general associated with increased mortality, the effects of an increase are most predominant in patients with higher levels of serum P, whereas a negative directional range are most predominant in patients with low serum P. This could be explained by the fact that patients with lower levels of P are generally malnourished or inflamed, where a further reduction indicates nutritional deterioration.

2179Clinical significance of device-derived activity in ICD and CRT-D patients - Data from MADIT-RIT

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Kutyifa ◽  
P Jones ◽  
I Goldenberg ◽  
M Brown ◽  
W Zareba ◽  
...  
Keyword(s):  
Daily Activity ◽  
Proportional Hazards ◽  
Nyha Class ◽  
Cox Proportional Hazards ◽  
Activity Level ◽  
Inappropriate Therapy ◽  
Class Iii ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
All Cause Mortality

Abstract Background The Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy (MADIT-RIT) enrolled 1500 patients and showed that novel ICD programming reduced inappropriate therapy and improved survival. However, the role of device-derived patient activity to predict mortality is not known. Methods In 1500 patients enrolled in MADIT-RIT, device-derived patient activity was captured daily. Device-derived activity was averaged for the first 30 days following randomization, and utilized in this study to predict mortality post-30 days. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models were used to evaluate all-cause mortality by 30-day device derived patient activity quintiles, and as a 3-level function of 30-day device derived patient activity (Q1, Q2–3, Q4–5). Results There were a total of 1463 patients with data available (98%), 66 of them died during the follow-up post-30 days. Patients in the lowest quintile (Q1: 4%∼1 hour daily activity) of device-derived activity were older, they were more often female, and they more often had diabetes and NYHA class III HF symptoms. Patients in the lowest quintile of 30-day device derived median activity (1 hour daily activity) had the highest risk of mortality, 15% in 2 years as compared to Q2–3 (1–2 hours daily activity, 8–7% 2-year mortality), and Q4–5 (>2 hours daily activity, 2–3% 2-year mortality) (Figure, p<0.001 for the overall duration). Each quintile decrease in device-derived 30-day median patient activity was associated with a significant, 41% increase in mortality (HR=1.41, 95% CI: 1.15–1.71, p=0.001). Patients with the lowest level of 30-day median patient activity (Q1) had 4.13-times higher risk of mortality as compared to the highest level of activity patients, Q4–5 (HR=4.13, 95% CI: 1.89–9.03, p<0.001). Patients with intermediate levels of activity (Q2–3) still had a 2.8-fold increase in death as compared to the highest activity level cohort of patients (HR=2.79, 95% CI: 1.31–5.91, p=0.008). Figure 1 Conclusions Device-derived 30-day median patient activity predicted subsequent all-cause mortality in ICD and CRT-D patients enrolled in MADIT-RIT. Patients with low and moderate levels of 30-day device-derived median patient activity (less than 2 hours daily activity) were at a significantly higher risk of death, and these cohorts warrant further investigation and management to improve outcomes. Acknowledgement/Funding MADIT-RIT was funded by an unrestricted research grant from Boston Scientific to the University of Rochester.

Inverse association of mortality and BMI in patients with cardiomyopathy of any etiology

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Brazile ◽  
S Mulukutla ◽  
F Thoma ◽  
S Saba
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Obesity Paradox ◽  
Left Ventricular ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Left Ventricular Ejection ◽  
Hazards Model ◽  
All Cause Mortality

Abstract Background Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and patients' outcomes, the “obesity paradox”, in several diseases. Purpose We sought to evaluate whether the obesity paradox applies to cardiomyopathy patients of all etiologies, using all-cause mortality as the primary endpoint. Methods We conducted a retrospective study of cardiomyopathy patients (n=18,003) seen within the UPMC network between January 2011 and December 2017. Patients were divided into 4 BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF): &lt;20%, 20–35%, and 36–50%. A Cox proportional hazards model was created to assess the independent predictive value of BMI on mortality. Results Over a median follow-up of 2.28 years, higher BMI was associated with better survival for the overall cohort (Figure) and within LVEF strata (p&lt;0.0001). The most common cause of hospitalization was subendocardial infarction among underweight and normal weight patients and heart failure among overweight and obese patients. Cox proportional hazards model showed that BMI, age, and comorbid conditions of COPD, CKD, and CAD are independent predictors of death. Conclusion Our results support the existence of an obesity paradox impacting all-cause mortality in cardiomyopathy patients of all etiologies even after adjusting for LVEF. Additional research is needed to understand the effect of weight loss on survival once a diagnosis of cardiomyopathy is established. Figure 1. Kaplan-Meier Survival Estimates Funding Acknowledgement Type of funding source: None

Abstract MP035: The Clinical Epidemiology of Fatigue in Newly Diagnosed Heart Failure

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Brent Williams
Keyword(s):  
Heart Failure ◽  
Health Care Services ◽  
Proportional Hazards ◽  
Clinical Epidemiology ◽  
Cox Proportional Hazards ◽  
P Value ◽  
Newly Diagnosed ◽  
Volume Depletion ◽  
All Cause Mortality ◽  
Overall Mortality

Introduction: Fatigue is a common and distressing, but poorly understood symptom among patients with heart failure (HF). The underlying mechanisms of fatigue in HF have not been clearly elucidated, but may lie in both psychologic and physiologic factors. Whether fatigue remains associated with mortality independent of other common clinical attributes also remains unresolved. Accordingly, the current study sought to evaluate the prevalence, predictors, and prognostic value of clinically documented fatigue in newly diagnosed HF patients. Methods: This retrospective cohort study consisted of 12,285 newly diagnosed HF patients receiving health care services through the Geisinger Health System, with passive data collection through electronic medical records (EMR). Incident HF, fatigue, and other study variables were derived from coded data within EMRs. A collection of 87 candidate predictors were evaluated to ascertain the strongest independent predictors of fatigue using logistic regression. The collection of candidate variables was drawn from several domains including demographics, physical examination findings, medical history, laboratory results, and medications. Patients were followed for all-cause mortality for an average of 4.8 years. The associations between fatigue and six-month, 12-month, and overall mortality were evaluated with Cox proportional hazards regression. Results: Clinically documented fatigue was found in 4827 (39%) newly diagnosed HF patients. Among the 87 candidate predictors, 18 were independently associated with fatigue at a multivariable p-value threshold of 0.001. Depression was the strongest predictor of fatigue. Fatigue was often part of a symptom cluster, as other HF symptoms including dyspnea, chest pain, edema, syncope, and palpitations were significant predictors of fatigue. Volume depletion, low body mass index, and abnormal weight loss were also strong predictors of fatigue. Though fatigue was significantly associated with 6-month (HR=1.49, p<0.01), 12-month (HR=1.39, p<0.01), and all-cause mortality (HR=1.20, p<0.01) in unadjusted models, effect sizes were attenuated and non-significant after adjustment for clinical variables with HRs of 1.12 (p=0.16), 1.07 (p=0.26), and 1.00 (p=0.89), for 6-month, 12-month, and overall mortality, respectively. Conclusions: Fatigue is a commonly documented symptom among newly diagnosed HF patients with likely origins in both psychologic and physiologic factors. Though fatigue provided a prognostic signal in the short-term, this was largely explained by physiologic confounders.

scholarly journals High School Quality and 56-Year All-Cause Mortality Risk Across Race and Ethnicity

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 505-506
Author(s):  
Dominika Seblova ◽  
Kelly Peters ◽  
Susan Lapham ◽  
Laura Zahodne ◽  
Tara Gruenewald ◽  
...  
Keyword(s):  
High School ◽  
Mortality Risk ◽  
Race And Ethnicity ◽  
Proportional Hazards ◽  
School Quality ◽  
Cox Proportional Hazards ◽  
School Level ◽  
Lower Mortality ◽  
All Cause Mortality ◽  
Race Ethnicity

Abstract Having more years of education is independently associated with lower mortality, but it is unclear whether other attributes of schooling matter. We examined the association of high school quality and all-cause mortality across race/ethnicity. In 1960, about 5% of US high schools participated in Project Talent (PT), which collected information about students and their schools. Over 21,000 PT respondents were followed for mortality into their eighth decade of life using the National Death Index. A school quality factor, capturing term length, class size, and teacher qualifications, was used as the main predictor. First, we estimated overall and sex-stratified Cox proportional hazards models with standard errors clustered at the school level, adjusting for age, sex, composite measure of parental socioeconomic status, and 1960 cognitive ability. Second, we added an interaction between school quality and race/ethnicity. Among this diverse cohort (60% non-Hispanic Whites, 23% non-Hispanic Blacks, 7% Hispanics, 10% classified as another race/s) there were 3,476 deaths (16.5%). School quality was highest for Hispanic respondents and lowest for non-Hispanic Blacks. Non-Hispanic Blacks also had the highest mortality risk. In the whole sample, school quality was not associated with mortality risk. However, higher school quality was associated with lower mortality among those classified as another race/s (HR 0.75, 95% CI: 0.56-0.99). For non-Hispanic Blacks and Whites, the HR point estimates were unreliable, but suggest that higher school quality is associated with increased mortality. Future work will disentangle these differences in association of school quality across race/ethnicity and examine cause-specific mortality.

scholarly journals Association of mushroom consumption with all-cause and cause-specific mortality among American adults: prospective cohort study findings from NHANES III

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Djibril M. Ba ◽  
Xiang Gao ◽  
Joshua Muscat ◽  
Laila Al-Shaar ◽  
Vernon Chinchilli ◽  
...  
Keyword(s):  
Lower Risk ◽  
Proportional Hazards ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Dietary Factors ◽  
Mortality Data ◽  
Nhanes Iii ◽  
Dietary Recall ◽  
All Cause Mortality ◽  
Specific Mortality

Abstract Background Whether mushroom consumption, which is rich in several bioactive compounds, including the crucial antioxidants ergothioneine and glutathione, is inversely associated with low all-cause and cause-specific mortality remains uncertain. This study aimed to prospectively investigate the association between mushroom consumption and all-cause and cause-specific mortality risk. Methods Longitudinal analyses of participants from the Third National Health and Nutrition Examination Survey (NHANES III) extant data (1988–1994). Mushroom intake was assessed by a single 24-h dietary recall using the US Department of Agriculture food codes for recipe foods. All-cause and cause-specific mortality were assessed in all participants linked to the National Death Index mortality data (1988–2015). We used Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause and cause-specific mortality. Results Among 15,546 participants included in the current analysis, the mean (SE) age was  44.3 (0.5) years. During a mean (SD) follow-up duration of 19.5 (7.4) years , a total of 5826 deaths were documented. Participants who reported consuming mushrooms had lower risk of all-cause mortality compared with those without mushroom intake (adjusted hazard ratio (HR) = 0.84; 95% CI: 0.73–0.98) after adjusting for demographic, major lifestyle factors, overall diet quality, and other dietary factors including total energy. When cause-specific mortality was examined, we did not observe any statistically significant associations with mushroom consumption. Consuming 1-serving of mushrooms per day instead of 1-serving of processed or red meats was associated with lower risk of all-cause mortality (adjusted HR = 0.65; 95% CI: 0.50–0.84). We also observed a dose-response relationship between higher mushroom consumption and lower risk of all-cause mortality (P-trend = 0.03). Conclusion Mushroom consumption was associated with a lower risk of total mortality in this nationally representative sample of US adults.

Elevated Serum Trimethylamine N-Oxide Levels Are Associated with Mortality in Male Patients on Peritoneal Dialysis

2021 ◽  
pp. 1-11
Author(s):  
Dongying Fu ◽  
Jiani Shen ◽  
Wei Li ◽  
Yating Wang ◽  
Zhong Zhong ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Elevated Serum ◽  
Ultra Performance Liquid Chromatography ◽  
Cox Proportional Hazards ◽  
Serum Samples ◽  
Entire Cohort ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Male Patients

Background: Elevated levels of serum trimethylamine N-oxide (TMAO) have been previously linked to adverse cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the clinical significance of serum TMAO levels in patients treated with peritoneal dialysis (PD) is unclear. Methods: A total of 1,032 PD patients with stored serum samples at baseline were enrolled in this prospective study. Serum concentrations of TMAO were quantified by ultra-performance liquid chromatography-tandem mass spectrometry. Cox proportional hazards and competing-risk regression models were performed to examine the association of TMAO levels with all-cause and CV mortality. Results: The median level of serum TMAO in our study population was 34.5 (interquartile range (IQR), 19.8–61.0) μM. During a median follow-up of 63.7 months (IQR, 43.9–87.2), 245 (24%) patients died, with 129 (53%) deaths resulting from CV disease. In the entire cohort, we observed an association between elevated serum TMAO levels and all-cause mortality (adjusted subdistributional hazard ratio [SHR], 1.22; 95% confidence interval [95% CI], 1.01–1.48; p = 0.039) but not CV mortality. Further analysis revealed such association differed by sex; the elevation of serum TMAO levels was independently associated with increased risk of both all-cause (SHR, 1.37; 95% CI, 1.07–1.76; p = 0.013) and CV mortality (SHR, 1.41; 95% CI, 1.02–1.94; p = 0.038) in men but not in women. Conclusions: Higher serum TMAO levels were independently associated with all-cause and CV mortality in male patients treated with PD.

scholarly journals First-phase ejection fraction by cardiovascular magnetic resonance predicts outcomes in aortic stenosis

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Haotian Gu ◽  
Rong Bing ◽  
Calvin Chin ◽  
Lingyun Fang ◽  
Audrey C. White ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Proportional Hazards ◽  
Function Analysis ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Cox Proportional Hazards

Abstract Background First-phase ejection fraction (EF1; the ejection fraction measured during active systole up to the time of maximal aortic flow) measured by transthoracic echocardiography (TTE) is a powerful predictor of outcomes in patients with aortic stenosis. We aimed to assess whether cardiovascular magnetic resonance (CMR) might provide more precise measurements of EF1 than TTE and to examine the correlation of CMR EF1 with measures of fibrosis. Methods In 141 patients with at least mild aortic stenosis, we measured CMR EF1 from a short-axis 3D stack and compared its variability with TTE EF1, and its associations with myocardial fibrosis and clinical outcome (aortic valve replacement (AVR) or death). Results Intra- and inter-observer variation of CMR EF1 (standard deviations of differences within and between observers of 2.3% and 2.5% units respectively) was approximately 50% that of TTE EF1. CMR EF1 was strongly predictive of AVR or death. On multivariable Cox proportional hazards analysis, the hazard ratio for CMR EF1 was 0.93 (95% confidence interval 0.89–0.97, p = 0.001) per % change in EF1 and, apart from aortic valve gradient, CMR EF1 was the only imaging or biochemical measure independently predictive of outcome. Indexed extracellular volume was associated with AVR or death, but not after adjusting for EF1. Conclusions EF1 is a simple robust marker of early left ventricular impairment that can be precisely measured by CMR and predicts outcome in aortic stenosis. Its measurement by CMR is more reproducible than that by TTE and may facilitate left ventricular structure–function analysis.

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