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Predictors of severe clinical outcomes in patients with severe aortic stenosis combined with small left ventricle

Authors: Demchenko E.A., Slivneva I.V., Petrosyan K.V., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2025-19-3-285-295

For citation: Demchenko E.A., Slivneva I.V., Petrosyan K.V., Golukhova E.Z. Predictors of severe clinical outcomes in patients with severe aortic stenosis combined with small left ventricle. Creative Cardiology. 2025; 19 (3): 285–295 (in Russ.). DOI: 10.24022/1997- 3187-2025-19-3-285-295

Received / Accepted:  28.04.2025 / 13.07.2025

Keywords: small left ventricle severe aortic stenosis classification of aortic stenosis valvuloarterial impedance left ventricular hypertrophy diastolic dysfunction



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Abstract

Aortic stenosis (AS) is one of the most significant pathologies of the valvular apparatus of the heart, representing an important medical and social problem. The prognosis of the disease even after surgical or transcatheter treatment is determined by a number of interrelated factors. Despite significant progress in the study of the pathophysiology of AS, the effect of small left ventricular (LV) on postoperative outcomes has not been sufficiently studied. In addition, there is no consensus on the optimal timing of surgical intervention in this category of patients. The aim of this study is to systematize modern data on various prognostic markers in severe AS in combination with small LV. The literature review used the search engines Elibrary, Google Scholar, PubMed. Publications for 2012–2025 were studied, older publications were also used to write some sections.

References

  1. Dweck M.R., Loganath K., Bing R., Treibel T.A., McCann G.P., Newby D.E. et al. Multi-modality imaging in aortic stenosis: an EACVI clinical consensus document. Eur. Heart J. Cardiovasc. Imaging. 2023; 24 (11): 1430–1443. DOI: 10.1093/ehjci/jead153
  2. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Russian Journal of Cardiology. 2022; 27 (7): 5160 (in Russ.). DOI: 10.15829/1560-4071-2022-5160
  3. Faggiano P., Antonini-Canterin F., Baldessin F., Lorusso R., D'Aloia A., Cas L.D. Epidemiology and cardiovascular risk factors of aortic stenosis. Cardiovasc. Ultrasound. 2006; 4: 27. DOI: 10.1186/1476-7120-4-27
  4. Aronow W.S., Schwartz K.S., Koenigsberg M. Correlation of serum lipids, calcium, and phosphorus, diabetes mellitus and history of systemic hypertension with presence or absence of calcified or thickened aortic cusps or root in elderly patients. Am. J. Cardiol. 1987; 59 (9): 998–999. DOI: 10.1016/0002-9149(87)91144-1
  5. Petrosyan K.V., Dadabaev G.M., Slivneva I.V., Chobanyan M.A. Clinical and genetic predictors of the development of calcified aortic stenosis. Creative Cardiology. 2024; 18 (3): 309–316 (in Russ.). DOI: 10.24022/1997-3187-2024-18-3-309-316
  6. Otto C.M., Nishimura R.A., Bonow R.O., Carabello B.A., Erwin J.P. 3rd, Gentile F. et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology / American Heart Association Joint Committee on clinical practice guidelines. J. Am. Coll. Cardiol. 2021; 77 (4): 509. DOI: 10.1161/CIR.0000000000000932
  7. Dulgheru R., Pibarot P., Sengupta P.P., Piérard L.A., Rosenhek R., Magne J. et al. Multimodality imaging strategies for the assessment of aortic stenosis: viewpoint of the Heart Valve Clinic International Database (HAVEC) Group. Circ. Cardiovasc. Imaging. 2016; 9 (2): e004352. DOI: 10.1161/CIRCIMAGING. 115.004352
  8. Eleid M.F., Sorajja P., Michelena H.I., Malouf J.F., Scott C.G., Pellikka P.A. Flow-gradient patterns in severe aortic stenosis with preserved ejection fraction: clinical characteristics and predictors of survival. Circulation. 2013; 128 (16): 1781–1789. DOI: 10.1161/CIRCULATIONAHA.113.003695
  9. Lancellotti P., Magne J., Donal E., Davin L., O'Connor K., Ros-ca M. et al. Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification. J. Am. Coll. Cardiol. 2012; 59 (3): 235–243. DOI: 10.1016/j.jacc.2011.08.072
  10. Monin J.L., Lancellotti P., Monchi M., Lim P., Weiss E., Piérard L., Guéret P. Risk score for predicting outcome in patients with asymptomatic aortic stenosis. Circulation. 2009; 120 (1): 69–75. DOI: 10.1161/CIRCULATIONAHA.108.808857
  11. NICE. Heart valve disease presenting in adults: investigation and management. NICE Guideline 208. NICE, 2021. https://www.nice.org.uk/guidance/ng208 (accessed July 13, 2025).
  12. Magne J., Cosyns B., Popescu B.A., Carstensen H.G., Dahl J., Desai M.Y. et al. Distribution and prognostic significance of left ventricular global longitudinal strain in asymptomatic significant aortic stenosis: an individual participant data meta-analysis. JACC Cardiovasc. Imaging. 2019; 12 (1): 84–92. DOI: 10.1016/j.jcmg.2018.11.005
  13. Gu H., Saeed S., Boguslavskyi A., Carr-White G., Chambers J.B., Chowienczyk P. First-phase ejection fraction is a powerful predictor of adverse events in asymptomatic patients with aortic stenosis and preserved total ejection fraction. JACC Cardiovasc. Imaging. 2019; 12 (1): 52–63. DOI: 10.1016/j.jcmg.2018.08.037
  14. Bahlmann E., Gerdts E., Cramariuc D., Gohlke-Baerwolf C., Nienaber C.A., Wachtell K. et al. Prognostic value of energy loss index in asymptomatic aortic stenosis. Circulation. 2013; 127 (10): 1149–1156. DOI: 10.1161/CIRCULATIONAHA.112.078857
  15. Altes A., Ringle A., Bohbot Y., Bouchot O., Appert L., Guerbaai R.A. et al. Clinical significance of energy loss index in patients with low- gradient severe aortic stenosis and preserved ejection fraction. Eur. Heart J. Cardiovasc. Imaging. 2020; 21 (6): 608–615. DOI: 10.1093/ehjci/jeaa010
  16. Hachicha Z., Dumesnil J.G., Pibarot P. Usefulness of the valvuloarterial impedance to predict adverse outcome in asymptomatic aortic stenosis. J. Am. Coll. Cardiol. 2009; 54 (11): 1003–1011. DOI: 10.1016/j.jacc.2009.04.079
  17. Mantha Y., Futami S., Moriyama S., Hieda M. Valvulo-arterial impedance and dimensionless index for risk stratifying patients with severe aortic stenosis. Front. Cardiovasc. Med. 2021; 8: 742297. DOI: 10.3389/fcvm.2021.742297
  18. Lan N.S.R., Ihdayhid A.R., Boardman G., Strange G., Playford D., Dwivedi G. Valvuloarterial impedance and 5-year mortality in severe aortic stenosis. Anatol. J. Cardiol. 2023; 27 (3): 132–134. DOI: 10.14744/AnatolJCardiol.2022.2498
  19. Golukhova E.Z., Slivneva I.V., Farulova I.Y., Skopin I.I., Marapov D.I., Murysova D.V. et al. Advantages of multiposition scanning in echocardiographic assessment of the severity of discordant aortic stenosis. Pathophysiology. 2023; 30: 174–185. DOI: 10.3390/pathophysiology30020015
  20. Slivneva I.V., Farulova I.Yu., Golukhova E.Z., Skopin I.I., Murysova D.V., Pirushkina Yu.D. Polypositional approach to assessing the severity of aortic stenosis. Serdechno-sosudistye zabolevaniya. Byulleten' NTSSSKh im. A.N. Bakuleva RAMN. 2023; 24 (S3): 124.
  21. Hein S., Arnon E., Kostin S., Schönburg M., Elsässer A., Polyakova V. et al. Progression from compensated hypertrophy to failure in the pressure-overloaded human heart: structural deterioration and compensatory mechanisms. Circulation. 2003; 107 (7): 984–991. DOI: 10.1161/01.cir.0000051865.66123.b7
  22. Krayenbuehl H.P., Hess O.M., Monrad E.S., Schneider J., Mall G., Turina M. Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement. Circulation. 1989; 79 (4): 744–755. DOI: 10.1161/01.cir.79.4.744
  23. Nigri M., Azevedo C.F., Rochitte C.E., Schraibman V., Tarasoutchi F., Pommerantzeff P.M. et al. Contrast-enhanced magnetic resonance imaging identifies focal regions of intramyocardial fibrosis in patients with severe aortic valve disease: correlation with quantitative histopathology. Am. Heart J. 2009; 157 (2): 361–368. DOI: 10.1016/j.ahj.2008.09.012
  24. Komlev A.E., Saidova M.A., Imaev T.E., Shitov V.N., Akchurin R.S. Haemodynamic patterns of severe aortic stenosis. Rational Pharmacother. Cardiol. 2020; 16 (5): 822–830 (in Russ.). DOI: 10.20996/1819-6446-2020-10-06
  25. Ageev F.T., Ovchinnikov A.G., Ageeva S.F., Mareev V.Yu. What is “normal left ventricular ejection fraction” and its relationship with the pathogenesis and effectiveness of the treatment of heart failure. Kardiologiia. 2023; 63 (6): 69–74 (in Russ.). DOI: 10.18087/ cardio.2023.6.n2404
  26. Rader F., Sachdev E., Arsanjani R., Siegel R.J. Left ventricular hypertrophy in valvular aortic stenosis: mechanisms and clinical implications. Am. J. Med. 2015; 128 (4): 344–352. DOI: 10.1016/j.amjmed.2014.10.054
  27. Stein E.J., Fearon W.F., Elmariah S., Kim J.B., Kapadia S., Kumbhani D.J. et al. Left ventricular hypertrophy and biomarkers of cardiac damage and stress in aortic stenosis. J. Am. Heart Assoc. 2022; 11(7): e023466. DOI: 10.1161/JAHA.121.023466
  28. Faggiano P., Frattini S., Zilioli V., Rossi A., Nistri S., Dini F.L. et al. Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process. Int. J. Cardiol. 2012; 159 (2): 94–99. DOI: 10.1016/j.ijcard.2011.02.026
  29. Playford D., Schwarz N., Chowdhury E., Williamson A., Duong M., Kearney L. et al. Comorbidities and symptom status in moderate and severe aortic stenosis: a multicenter clinical cohort study. JACC Adv. 2023; 2 (4): 100356. DOI: 10.1016/j.jacadv.2023.100356
  30. Osnabrugge R.L., Mylotte D., Head S.J., Van Mieghem N.M., Nkomo V.T., LeReun C.M. et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J. Am. Coll. Cardiol. 2013; 62 (11): 1002–1012. DOI: 10.1016/j.jacc.2013.05.015
  31. Fleg J.L., Strait J. Age-associated changes in cardiovascular structure and function: a fertile milieu for future disease. Heart Fail. Rev. 2012; 17 (4–5): 545–554. DOI: 10.1007/s10741-011-9270-2
  32. Carabello B.A. Introduction to aortic stenosis. Circ. Res. 2013; 113 (2): 179–185. DOI: 10.1161/CIRCRESAHA.113.300156
  33. Marcus M.L., Doty D.B., Hiratzka L.F., Wright C.B., Eastham C.L. Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N. Engl. J. Med. 1982; 307 (22): 1362–1366. DOI: 10.1056/NEJM198211253072202
  34. Spann J.F., Bove A.A., Natarajan G., Kreulen T. Ventricular performance, pump function and compensatory mechanisms in patients with aortic stenosis. Circulation. 1980; 62 (3): 576–582. DOI: 10.1161/01.cir.62.3.576
  35. Perry A.S., Zhao S., Murthy V., Gupta D.K., Fearon W.F., Kim J.B. et al. Metabolic signatures of cardiac dysfunction, multimorbidity, and post-transcatheter aortic valve implantation death. J. Am. Heart Assoc. 2023; 12 (13): e029542. DOI: 10.1161/JAHA.123.029542
  36. Monga S., Valkovič L., Tyler D., Lygate C.A., Rider O., Myerson S.G. et al. Insights into the metabolic aspects of aortic stenosis with the use of magnetic resonance imaging. JACC Cardiovasc. Imaging. 2022; 15 (12): 2112–2126. DOI: 10.1016/j.jcmg.2022.04.025
  37. Monga S., Valkovič L., Myerson S.G., Neubauer S., Mahmod M., Rider O.J. Role of cardiac energetics in aortic stenosis disease progression: identifying the high-risk metabolic phenotype. Circ. Cardiovasc. Imaging. 2023; 16 (10): e014863. DOI: 10.1161/CIRCIMAGING.122.014863
  38. Zelis J.M., Tonino P.A.L., Pijls N.H.J., De Bruyne B., Kirkeeide R.L., Gould K.L., Johnson N.P. Coronary microcirculation in aortic stenosis: pathophysiology, invasive assessment, and future directions. J. Interv. Cardiol. 2020; 2020: 4603169. DOI: 10.1155/2020/4603169
  39. McConkey H.Z.R., Marber M., Chiribiri A., Pibarot P., Redwood S.R., Prendergast B.D. Coronary microcirculation in aortic stenosis. Circ. Cardiovasc. Interv. 2019; 12 (8): e007547. DOI: 10.1161/CIRCINTERVENTIONS.118.007547
  40. Scarsini R., Gallinoro E., Ancona M.B., Portolan L., Paolisso P., Springhetti P. et al. Characterisation of coronary microvascular dysfunction in patients with severe aortic stenosis undergoing TAVI. EuroIntervention. 2024; 20 (5): e289–e300. DOI: 10.4244/EIJ-D-23-00735
  41. Chambers J. The left ventricle in aortic stenosis: evidence for the use of ACE inhibitors. Heart. 2006; 92 (3): 420–423. DOI: 10.1136/hrt.2005.074112
  42. Leibowitz D., Zwas D., Amir O., Gotsman I. Small left ventricular chamber size and mortality in a large general population. Am. J. Cardiol. 2025; 234: 14–21. DOI: 10.1016/j.amjcard. 2024.09.034
  43. Saito T., Inohara T., Yoshijima N., Yashima F., Tsuruta H., Shimizu H. et al. Small left ventricle and clinical outcomes after transcatheter aortic valve replacement. J. Am. Heart Assoc. 2021; 10 (7): e019543. DOI: 10.1161/JAHA.120.019543
  44. Skopin I.I., Slivneva I.V., Latyshev M.S., Murysova D.V., Asatryan T.V., Sokolskaya N.O. et al. Evaluation of predictors of persistence/ progression of functional mitral regurgitation in patients with interventional treatment of aortic valve defect. Pathology of Blood Circulation and Cardiac Surgery. 2019; 23 (2): 9–19. DOI: 10.21688/1681-3472-2019-2-9-19
  45. Owais T., El Garhy M., Fuchs J., Disha K., Elkaffas S., Breuer M. et al. Pathophysiological factors associated with left ventricular perforation in transcatheter aortic valve implantation by transfemoral approach. J. Heart Valve Dis. 2017; 26 (4): 430–436. PMID: 29302942
  46. Makeev M.I., Saidova M.A., Safiullina A.A., Komlev A.E., Kuchin I.V., Kantemirova M.M. et al. Prediction of cardiovascu-lar events and structural and functional remodeling of the heart in patients with severe mitral regurgitation of various genesis underwent transcatheter mitral valve repair “edge-to-edge”. Kardiologiia. 2024; 64 (9): 3–15 (in Russ.). DOI: 10.18087/cardio.2024.9.n2699
  47. Shirokov N.E., Enina T.N., Zueva E.V., Yaroslavskaya E.I., Krinochkin D.V., Musikhina N.A. et al. Relationship between the biomarkers of collagen regulation and echocardiography parameters in patients with heart failure with preserved ejection fraction. Kardiologiia. 2024; 64(12): 51–58 (in Russ.). DOI: 10.18087/cardio.2024.12.n2706
  48. Varionchik N.V., Blagova O.V., Pavlenko E.V., Nedostup A.V., Sedov V.P., Gagarina N.V. et al. Adverse events in patients with left ventricular noncompaction: risk stratification and treatment options. Kardiologiia. 2024; 64 (6): 3–11 (in Russ.). DOI: 10.18087/cardio.2024.6.n2502
  49. Babeshko S.S., Barbukhatti K.O., Shumkov D.I., Kaleda V.I., Porhanov V.A. Predictors of adverse outcomes in early and long-term periods after aortic valve replacement in patients with severe left ventricular systolic dysfunction. Russian Journal of Thoracic and Cardiovascular Surgery. 2024; 66 (2): 166–177 (in Russ.). DOI: 10.24022/0236-2791-2024-66-2-166-177
  50. Tambieva F.O., Rychin S.V. Aortic valve replacement in patients with severe aortic stenosis and restrictive diastolic dysfunction of the left ventricle. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2025; 67 (2): 142–149 (in Russ.). DOI: 10.24022/0236-2791-2025-67-2-142-149
  51. Babenko S.I., Titov D.A., Meshchanov B.V., Muratov R.R., Shapovalov S.A. Immediate results of aortic valve’s replacement in patients over 80 years of age with critical degenerative stenosis. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2025; 67 (2): 159–166 (in Russ.). DOI: 10.24022/0236-2791-2025-67-2-159-166
  52. Olofinskaya I.E., Nersisyan M.M., Goncharuk Yu.V., Aleksa-nyan G.G., Dumpe A.N., Darvish N.A. et al. Quality of life of elderly patients after surgical treatment of aortic valve disease in combination with atherosclerotic carotid arteries disease: mid term follow up. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66 (5): 645–654 (in Russ.). DOI: 10.24022/0236-2791-2024-66-5-645-654
  53. Shamsiev G.A., Nikitina T.G., Abdulloev O.K., Lazarev R.A., Khammud F.A., Zakirov F.I. Evaluation of immediate and mid-term results of treatment of patients with severe aortic stenosis and low left ventricular contractility. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2022; 64(1): 50–63 (in Russ.). DOI: 10.24022/0236-2791-2022-64-1-50-63

About Authors

  • Elizaveta A. Demchenko, Cardiologist, Postgraduate; ORCID
  • Inessa V. Slivneva, Cand. Med. Sci., Head of the Cardiac Imaging and Innovative Technologies Group, Ultrasound Diagnostician; ORCID
  • Karen V. Petrosyan, Dr. Med. Sci., Head of the Department of X-ray Surgical Diagnostic and Treatment Methods, Endovascular Surgeon; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of the Russian Academy of Sciences, Director; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


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