Outcomes of pseudo-severe aortic stenosis under conservative treatment
| Autor: | Hélène Petit-Eisenmann, Pascal Gueret, Damien Metz, Christophe Tribouilloy, Agnes Pasquet, Serge Baleynaud, Jean-Luc Monin, Mehran Monchi, Christophe Chauvel, Emilie Fougeres, Dan Rusinaru, Catherine Adams |
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| Rok vydání: | 2012 |
| Předmět: |
Male
Digoxin medicine.medical_specialty Adrenergic beta-Antagonists Angiotensin-Converting Enzyme Inhibitors Kaplan-Meier Estimate macromolecular substances Angiotensin Receptor Antagonists Internal medicine medicine Humans In patient Prospective Studies Prospective cohort study Aged Aged 80 and over business.industry Aortic Valve Stenosis medicine.disease Surgery Conservative treatment Clinical trial Stenosis Treatment Outcome Aortic valve stenosis Heart failure Cardiology Female Dobutamine Cardiology and Cardiovascular Medicine business Echocardiography Stress Heart Failure Systolic medicine.drug |
| Zdroj: | European Heart Journal. 33:2426-2433 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehs176 |
| Popis: | In the setting of low-flow/low-gradient aortic stenosis (LF/LGAS), outcomes of pseudo-severe aortic stenosis (AS) remain poorly described. This study was aimed to assess the outcome of patients with pseudo-severe AS under conservative treatment.Among 305 patients from the European Registry of LF/LGAS, the outcomes of the 107 patients followed under conservative treatment were analysed. Based on the results of dobutamine echocardiography, patients were divided into group IA [left ventricular (LV) contractile reserve present with true-severe AS, n = 43], group IB [pseudo-severe AS (n = 29) defined as LV contractile reserve with a final aortic valve area ≥1.2 cm(2) and a mean transaortic pressure gradient40 mmHg at peak dobutamine infusion], or group II (exhausted LV contractile reserve, n = 35). The rate of death within 5 years was significantly lower in the group IB (43 ± 11%, n = 10), when compared with the group IA (91 ± 6%, n = 33; P = 0.001) and the group II (100%, n = 23; P0.001). The Cox proportional hazard model analysis demonstrated that the hazard ratio for death in the group IB remained significantly lower than in the other groups, even after adjustment for currently established risk factors. Furthermore, the 5-year survival of pseudo-severe AS patients was comparable with that of propensity-matched patients with systolic heart failure and no evidence of valve disease.In patients with pseudo-severe AS, the 5-year survival under conservative treatment is better than in true-severe AS and comparable with that of propensity-matched patients with LV systolic dysfunction and no evidence of valve disease. Further studies are needed to define optimal therapeutic management in these patients. |
| Databáze: | OpenAIRE |
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