DOI: http://doi.org/10.1016/j.echo.2025.04.008
The Journal of the American Society of Echocardiography recently published an online research paper titled Impact of Renal Function on Myocardial Remodeling and Outcomes in Patients with Moderate Aortic Stenosis on April 17, 2025. This study focuses on the impact of renal function on myocardial remodeling and clinical outcomes in patients with moderate aortic stenosis (AS), revealing important prognostic factors beyond traditional valvular hemodynamics.
The research team analyzed data from 865 patients with moderate AS from 2008 to 2020 and found that the deterioration of renal function is closely associated with significant changes in myocardial structure and function. Specifically, as the stage of chronic kidney disease (CKD) increases, patients experience a significant rise in valvular-arterial impedance, more severe left ventricular hypertrophy, poorer diastolic function, and a notable decline in the strain capacity of the left ventricle and left atrium. These myocardial remodeling phenomena are related to renal function itself rather than the severity of AS.
During a median follow-up of four years, nearly 40% of patients experienced adverse events such as death or hospitalization due to heart failure. Among these, advanced CKD (stage 4 to 5) and significant myocardial dysfunction were confirmed as independent predictors of clinical outcome deterioration. This association remained significant after adjusting for key variables such as patient age, gender, comorbidities, and whether they underwent aortic valve replacement. Furthermore, mediation effect analysis indicated that myocardial dysfunction plays a partial mediating role in the impact of renal function on prognosis.
This study suggests that current treatment strategies for patients with moderate AS may need to be updated. Historically, attention has focused on the degree of valvular stenosis itself, often overlooking the profound effects of systemic factors such as renal function on cardiac structure and function. The authors point out that for patients whose cardiac damage primarily stems from comorbidities rather than valvular stenosis itself, whether to initiate active treatment (such as valve replacement) earlier warrants further research and discussion.
This research not only provides a new perspective for assessing the risk in patients with moderate AS but also emphasizes the importance of a comprehensive evaluation of the patient’s overall condition in cardiovascular disease management. With the aging population and rising incidence of CKD, these findings are expected to provide more precise intervention guidelines for clinical practice.