{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:06:10Z","timestamp":1791446770593,"version":"4.3.3"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,4,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The optimal threshold of left ventricular ejection fraction (LVEF) that should prompt aortic valve replacement (AVR) in asymptomatic patients with high\u2010gradient severe aortic stenosis (AS) is controversial. The aim of this study was to assess the relationship between LVEF and mortality benefit in comparing early AVR versus watchful waiting in asymptomatic patients with severe AS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              MEDLINE, Embase, Web of Science, and Google Scholar were searched for observational studies and randomized controlled trials on adults with asymptomatic severe AS. Severe AS was defined by a peak aortic velocity \u22654\u00a0m\/s and\/or mean aortic valve gradient \u226540\u00a0mm\u00a0Hg and\/or calculated aortic valve area &lt;1.0\u00a0cm\n              <jats:sup>2<\/jats:sup>\n              or an indexed valve area &lt;0.6\u00a0cm\n              <jats:sup>2<\/jats:sup>\n              . Studies comparing AVR with conservative management were included and meta\u2010analysis on all\u2010cause mortality was performed. Ten eligible studies were identified with a total of 3332 patients. In 5 observational studies comparing early AVR versus watchful waiting, our meta\u2010analysis showed early AVR was associated with lower mortality with a hazard ratio (HR) of 0.41 (CI, 0.23\u20130.71;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). In 4 observational studies comparing AVR versus no AVR, our meta\u2010analysis showed AVR was associated with lower mortality with a HR of 0.31 (CI, 0.17\u20130.58;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In a meta\u2010regression analysis pooling all 10 studies, there was no statistically significant correlation between study mean LVEF and the size of mortality benefit of AVR (\n              <jats:italic>P<\/jats:italic>\n              =0.83).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Among asymptomatic patients with high\u2010gradient severe AS, AVR was associated with a mortality benefit across the spectrum of LVEF. Our study calls into question the need of an LVEF threshold for recommending AVR in this patient population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020252","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T10:20:48Z","timestamp":1617186048000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Optimal Threshold of Left Ventricular Ejection Fraction for Aortic Valve Replacement in Asymptomatic Severe Aortic Stenosis: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3342-6158","authenticated-orcid":false,"given":"Andrew S.","family":"Perry","sequence":"first","affiliation":[{"name":"Division of Cardiology University of Washington School of Medicine Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0976-1386","authenticated-orcid":false,"given":"Song","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Washington School of Medicine Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-307020"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.38.1S5.V-61"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2003.12.002"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.02.537"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000503"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx391"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.10.2395"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.02.026"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_3_2_11_2","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.1 (Updated September 2020)","author":"Higgins JP","year":"2020","unstructured":"Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, eds. 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