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Paradoxical low-flow severe aortic stenosis (AS) despite preserved left ventricular ejection fraction is a recently described clinical entity.
To evaluate prognosis of paradoxical low-flow severe AS (stroke volume<35 mL/m2) in a cohort of Japanese patients, we identified patients with severe AS (aortic valve area<1.0cm2) with preserved ejection fraction (>=50%) in July 2007 to June 2011, and followed them to last follow-up or death. Cox-proportional hazards modeling was used to assess risk of all-cause mortality.
Of a total number of 164 consecutive patients with severe AS with preserved ejection fraction (mean age 76± 9 year-old, 40% men, mean aortic valve area 0.8± 0.2 cm2, 58% symptomatic, 76% hypertension, 24% diabetes, 49% chronic kidney disease), 26 (16%) were paradoxical low-flow severe AS. Of these, 58 (35%) underwent aortic valve replacement, and 23 (14%) died during a mean follow-up of 22± 18 months. After adjusting for comorbidities in a multivariate model, low-flow (stroke volume<35 mL/m2) was an independent predictor of all-cause mortality (hazard ratio=3.2, 95% confidence interval =1.3-8.0, P=0.01). The Kaplan-Meier estimates of events-free survival by flow status were shown (Fig.).
Patients with paradoxical low-flow severe AS have significantly poorer survival than those with normal-flow. This observation highlights the need for echocardiographic identification of patients with low-flow severe AS despite preserved ejection fraction.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Multimodality Imaging in Valvular Heart Disease
Abstract Category: 18. Imaging: Echo
Presentation Number: 1270-354
- 2013 American College of Cardiology Foundation