Prognosis of Paradoxical Low-Flow Low-Gradient Aortic Stenosis: A Severe, Non-critical Form, With Surgical Treatment Benefits.

Autor:	Galian-Gay L; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Escalona Silva RA; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Teixidó-Turà G; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Casas G; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Ferrer-Sistach E; Department of Cardiology, Hospital Universitari Germans Tries i Pujol, Badalona, Spain., Mitroi C; Department of Cardiology, Hospital Puerta de Hierro - Majadahonda, Madrid, Spain., Mingo S; Department of Cardiology, Hospital Puerta de Hierro - Majadahonda, Madrid, Spain., Monivas V; Department of Cardiology, Hospital Puerta de Hierro - Majadahonda, Madrid, Spain., Saura D; Department of Cardiology, CIBER-CV, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain., Vidal B; Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain., Trasca L; Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain., Moral S; Department of Cardiology, Hospital Josep Trueta, Girona, Spain., Calvo F; Department of Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain., Castiñeira Busto M; Department of Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain., Sánchez V; Department of Cardiology, CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain., Gonzalez A; Department of Cardiology, Hospital Ramón y Cajal, Madrid, Spain., Guzman G; Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain., Mora MN; Department of Cardiology, Hospital Universitario Son Espases, IdISBa, Mallorca, Spain., Arnau Vives M; Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Peteiro J; Department of Cardiology, CIBER-CV, Complexo Hospitalario Universitario A Coruña, Coruña, Spain., Bouzas A; Department of Cardiology, CIBER-CV, Complexo Hospitalario Universitario A Coruña, Coruña, Spain., Mas-Stachurska A; Department of Cardiology, Hospital del Mar - Parc de Salut Mar, Barcelona, Spain., González-Alujas T; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Gutiérrez L; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Fernandez-Galera R; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Valente F; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Guala A; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Ruiz-Muñoz A; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Avilés CAS; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Palomares JFR; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Ferreira I; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain., Evangelista A; Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Apr 01; Vol. 9, pp. 852954. Date of Electronic Publication: 2022 Apr 01 (Print Publication: 2022).
DOI:	10.3389/fcvm.2022.852954
Abstrakt:	Objectives: To determine the risk of mortality and need for aortic valve replacement (AVR) in patients with low-flow low-gradient (LFLG) aortic stenosis (AS). Methods: A longitudinal multicentre study including consecutive patients with severe AS (aortic valve area [AVA] < 1.0 cm 2 ) and normal left ventricular ejection fraction (LVEF). Patients were classified as: high-gradient (HG, mean gradient ≥ 40 mmHg), normal-flow low-gradient (NFLG, mean gradient < 40 mmHg, indexed systolic volume (SVi) > 35 ml/m 2 ) and LFLG (mean gradient < 40 mmHg, SVi ≤ 35 ml/m 2 ). Results: Of 1,391 patients, 147 (10.5%) had LFLG, 752 (54.1%) HG, and 492 (35.4%) NFLG. Echocardiographic parameters of the LFLG group showed similar AVA to the HG group but with less severity in the dimensionless index, calcification, and hypertrophy. The HG group required AVR earlier than NFLG ( p < 0.001) and LFLG ( p < 0.001), with no differences between LFLG and NFLG groups ( p = 0.358). Overall mortality was 27.7% ( CI 95% 25.3-30.1) with no differences among groups ( p = 0.319). The impact of AVR in terms of overall mortality reduction was observed the most in patients with HG (hazard ratio [ HR ]: 0.17; 95% CI : 0.12-0.23; p < 0.001), followed by patients with LFLG ( HR : 0.25; 95% CI : 0.13-0.49; p < 0.001), and finally patients with NFLG ( HR : 0.29; 95% CI : 0.20-0.44; p < 0.001), with a risk reduction of 84, 75, and 71%, respectively. Conclusions: Paradoxical LFLG AS affects 10.5% of severe AS, and has a lower need for AVR than the HG group and similar to the NFLG group, with no differences in mortality. AVR had a lower impact on LFLG AS compared with HG AS. Therefore, the findings of the present study showed LFLG AS to have an intermediate clinical risk profile between the HG and NFHG groups. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Galian-Gay, Escalona Silva, Teixidó-Turà, Casas, Ferrer-Sistach, Mitroi, Mingo, Monivas, Saura, Vidal, Trasca, Moral, Calvo, Castiñeira Busto, Sánchez, Gonzalez, Guzman, Mora, Arnau Vives, Peteiro, Bouzas, Mas-Stachurska, González-Alujas, Gutiérrez, Fernandez-Galera, Valente, Guala, Ruiz-Muñoz, Avilés, Palomares, Ferreira and Evangelista.)
Databáze:	MEDLINE
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