Predictors of Outcomes in Low-Flow, Low-Gradient Aortic Stenosis

• DOI: 10.1161/circulationaha.107.757427
• Publication Date: 2008-09-30T01:11:46Z
• Authors: Marie-Annick Clavel; Christina Fuchs; Ian G. Burwash; Gerald Mundigler; Jean G. Dumesnil; Helmut Baumgartner; Jutta Bergler-Klein; Rob S. Beanlands; Patrick Mathieu; Julien Magne; Philippe Pibarot
• Keywords: Aged, 80 and over; Heart Valve Prosthesis Implantation; Male; Exercise Tolerance; Aortic Valve Stenosis; Kaplan-Meier Estimate; Middle Aged; Severity of Illness Index; 3. Good health; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Regional Blood Flow; Aortic Valve; Humans; Female; Angioplasty, Balloon, Coronary; Coronary Artery Bypass; Aorta; Aged; Echocardiography, Stress; Follow-Up Studies

Background— Patients with low-flow, low-gradient aortic stenosis have a poor prognosis conservative therapy but high operative mortality if treated surgically. Recently, we proposed new index of severity derived from dobutamine stress echocardiography, the projected valve area at normal transvalvular flow rate, as superior to other conventional indices differentiate true-severe pseudosevere stenosis. The objective this study was identify determinants survival, functional status, and change in left ventricular ejection fraction during follow-up patients Methods Results— One hundred one (aortic ≤1.2 cm 2 , ≤40%, mean gradient ≤40 mm Hg) underwent echocardiography an assessment capacity using Duke Activity Status Index. A subset 72 also 6-minute walk test. Overall survival 70±5% 1 year 57±6% 3 years. After adjusting for age, gender, type treatment replacement versus no replacement), significant predictors were Index ≤20 ( P =0.0005) or test distance ≤320 m <0.0001, patients), rate =0.03), peak ≤35% =0.03). More severe stenosis, defined predictor only group. Index, test, improved significantly group, remained unchanged decreased Conclusion— In most risk factors outcome (1) impaired measured by distance; (2) more rate; (3) reduced fraction, composite measure accounting both resting function contractile reserve.