Valvuloarterial impedance does not improve risk stratification in low-ejection fraction, low-gradient aortic stenosis: results from a multicentre study
| Autor: | Dan Rusinaru, Claude Lelguen, Catherine Adams, Hélène Petit-Eisenmann, Francois Leleu, Christophe Chauvel, Jean Luc Monin, Christophe Tribouilloy, Pascal Gueret, Franck Levy, Damien Metz |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Statistics as Topic Risk Assessment Severity of Illness Index Statistics Nonparametric Ventricular Function Left Aortic valve replacement Afterload Internal medicine Confidence Intervals Odds Ratio Health Status Indicators Humans Medicine Radiology Nuclear Medicine and imaging Aged Retrospective Studies Valvuloarterial impedance Ejection fraction business.industry Hemodynamics Stroke Volume Aortic Valve Stenosis General Medicine Stroke volume Prognosis medicine.disease Stenosis Aortic valve stenosis Risk stratification Cardiology Female Cardiology and Cardiovascular Medicine business Echocardiography Stress |
| Zdroj: | European Journal of Echocardiography. 12:358-363 |
| ISSN: | 1532-2114 1525-2167 |
| DOI: | 10.1093/ejechocard/jer022 |
| Popis: | Objectives In a multicentre series of patients with low-ejection fraction/low-gradient aortic stenosis (LEF/LGAS), we evaluated the prognostic impact of valvuloarterial impedance (Zva). Background Zva in AS, a measure of global afterload taking into account systemic arterial compliance, has been proposed for risk stratification in paradoxical LGAS. We hypothesized that Zva could help risk stratification in LEF/LGAS. Methods and results We retrospectively calculated Zva (5.6 ± 1.7 mmHg/mL/m2) of 184 consecutive patients (mean age: 71 ± 10 years) with severe symptomatic LEF/LGAS (valve area ≤1 cm², EF ≤40%, mean transaortic pressure gradient ≤40 mmHg) included between 1995 and 2005 in a multicentre registry. Zva was higher in patients with LVEF at rest ≤20% (6.6 ± 2.3 vs. 5.5 ± 1.6; P = 0.05) and correlated negatively with LVEF at rest ( R = −0.25; P = 0.001). Zva was lower in patients without contractile reserve (CR) on dobutamine stress echocardiography (DSE) compared with patients with true severe AS (5.3 ± 1.3 vs. 5.8 ± 1.8 mmHg/mL/m2; P = 0.048). Zva and the variation in stroke volume during DSE were positively correlated ( P = 0.0001) but Zva did not allow distinction between true and pseudo-severe AS (5.8 ± 1.8 vs. 5.3 ± 1.8mmHg/mL/m2; P = 0.30). In the total population, Zva was not predictive of long-term mortality. In the 128 patients who underwent aortic valve replacement, Zva was not predictive of operative death and of long-term mortality. Conclusions Increased Zva is related to low LVEF and more frequent CR on DSE in LEF/LGAS. However, Zva did not allow an accurate distinction between true and pseudo-severe AS and failed to predict operative and long-term mortality after aortic valve replacement, in LEF/LGAS. |
| Databáze: | OpenAIRE |
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