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

Autor: Galian-Gay, Laura, Escalona Silva, Roxana Andreina, Teixido-Tura, Gisela, Casas, Guillem, Ferrer-Sistach, Elena, Mitroi, Cristina, Mingo, Susana, Monivas, Vanessa, Saura, Daniel, Vidal, Bàrbara, Trasca, Livia, Moral, Sergio, Calvo, Francisco, Castiñeira Busto, Maria, Sánchez, Violeta, Gonzalez, Ariana, Guzman, Gabriela, Mora, Marta Noris, Arnau Vives, Miguel Ángel, Peteiro, Jesús, Bouzas, Alberto, Mas-Stachurska, Aleksandra, González-Alujas, Teresa, Gutiérrez, Laura, Fernandez-Galera, Rubén, Valente, Filipa, Guala, Andrea, Ruiz-Muñoz, Aroa, Sao-Avilés, Augusto, Rodríguez-Palomares, José F., Ferreira, Ignacio, Evangelista, Artur, Universitat Autònoma de Barcelona
Přispěvatelé: Institut Català de la Salut, [Galian-Gay L, Escalona Silva RA, Teixidó-Turà G, Casas G, González-Alujas T, Gutiérrez L, Fernandez-Galera R, Valente F, Guala A, Ruiz-Muñoz A, Avilés CAS, Palomares JFR, Ferreira I, Evangelista A] Servei de Cardiologia, Vall d'Hebron Hospital Universitari, Barcelona, Spain. CIBER-CV, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, 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, Vall d'Hebron Barcelona Hospital Campus
Rok vydání: 2022
Předmět:
Zdroj: Dipòsit Digital de Documents de la UAB
Universitat Autònoma de Barcelona
Scientia
Frontiers In Cardiovascular Medicine
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
instname
ISSN: 2297-055X
Popis: ObjectivesTo determine the risk of mortality and need for aortic valve replacement (AVR) in patients with low-flow low-gradient (LFLG) aortic stenosis (AS).MethodsA longitudinal multicentre study including consecutive patients with severe AS (aortic valve area [AVA] < 1.0 cm2) 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/m2) and LFLG (mean gradient < 40 mmHg, SVi ≤ 35 ml/m2).ResultsOf 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.ConclusionsParadoxical 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.
Databáze: OpenAIRE
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