Author + information
- Received November 12, 2000
- Revision received March 1, 2001
- Accepted March 22, 2001
- Published online June 15, 2001.
- Jean-Luc Monin, MD∗,* (, )
- Mehran Monchi, MD†,
- Virginie Gest, MD∗,
- Anne-Marie Duval-Moulin, MD∗,
- Jean-Luc Dubois-Rande, MD, PhD∗ and
- Pascal Gueret, MD, FACC∗
- ↵*Reprint requests and correspondence:
Dr. J. L. Monin, Fédération de Cardiologie, Hôpital Henri Mondor, 51 Avenue De Lattre de Tassigny, 94010 Créteil, France
We sought to assess risk stratification by using dobutamine stress echocardiography (DSE) in patients with aortic stenosis (AS) and severe left ventricular (LV) dysfunction.
Few data are available on risk stratification for valve replacement in patients with AS, LV dysfunction and low transvalvular gradients.
Low-dose DSE was performed in 45 patients (16 women and 29 men; median [quartile range] age in years: 75 [69 to 79]; left ventricular ejection fraction: 0.29 [0.23 to 0.32]; aortic valve area [cm2]: 0.7 [0.5 to 0.8]; mean transaortic gradient [mm Hg]: 26 [21 to 33]). Patients were classified into two groups: group I (n = 32, LV contractile reserve on DSE) and group II (n = 13, no contractile reserve). Valve replacement was performed in 24 and 6 patients in groups I and II, respectively.
Perioperative mortality was 8% in group I and 50% in group II (p = 0.014). Survival at five years after the operation was 88% in group I. Compared with medical therapy, valve surgery was associated with better long-term survival in group I (hazard ratio for death [HR-D] 0.13, 95% confidence interval [CI] 0.002 to 0.49) and reduced survival in group II (HR-D 19.6, 95% CI 2.7 to 142). The effect of valve surgery on survival remained significant in both groups after adjustment for age, diabetes, respiratory disease and hypertension. Medical therapy had the same effect in both groups.
In patients with AS, LV dysfunction and low transvalvular gradients, contractile reserve on DSE is associated with a low operative risk and good long-term prognosis after valve surgery. In contrast, operative mortality remains high in the absence of contractile reserve.
☆ This study was supported in part by a grant from the Fédération Française de Cardiologie.
- Received November 12, 2000.
- Revision received March 1, 2001.
- Accepted March 22, 2001.
- American College of Cardiology