Author + information
- Frédéric Maes,
- Jamila Boulif,
- Christophe De Meester,
- Julie Melchior,
- Bernhard Gerber,
- David Vancraeynest,
- Anne–Catherine Pouleur,
- Agnes Pasquet and
- Jean–Louis Vanoverschelde
Recent studies have indicated that up to 30% of patients (pts) with severe aortic stenosis (SAS), defined as an indexed aortic valve area < 0.6 cm2/m2, present with low transvalvular gradient (LG) despite a normal left ventricular ejection fraction (LVEF). At present time, there is intense controversy as to the prognostic implications of such findings. Accordingly, the aim of the present work was to compare the natural history of pts with LG SAS to that of pts with high gradient (HG) SAS.
Since 2000, all pts with valvular heart diseases are enrolled into a prospective registry. From this registry, we identified 360 pts with SAS and a preserved LVEF (≥ 50%) who were initially managed conservatively (i.e. who were not operated on within the first 3 months after diagnosis). Pts were categorized according to mean transvalvular gradient (≤ ou > 40 mmHg) and indexed stroke volume (≤ ou > 35 ml/m2). The primary endpoint was all causes mortality. To evaluate natural history, pts undergoing surgery during follow–up were censored at the time of surgery (n=84).
145 had HG SAS (45%) and 215 had LG SAS (55%). During a mean follow–up of 36 ± 28 months, 154 patients died. Cox analysis identified age, NYHA class, the presence of diabetes and chronic obstructive lung disease as independant predictor of death. In the subgroup of asymptomatic pts, the same analysis identified age, the presence of diabetes and mean transvalvular gradient as independent predictors of death. Kaplan Meier survival curves demonstrated that survival was better in pts with LG SAS than in those with HG SAS, both in the overall population (47 vs 31%, p<0.01) and in the asymptomatic subgroup (58 vs 35%, p<0.03). By contrast, indexed stoke volume did not influence outcome.
In pts with SAS and normal LVEF, those with LG SAS have a better prognosis that those with HG SAS. Indexed stroke volume does not influence outcome.
West, Room 2010
Sunday, March 10, 2013, 11:00 a.m.–11:15 a.m.
Session Title: Valvular Heart Disease: Prognostic Features and Technical Advances to Optimize TAVR Outcomes
Abstract Category: 31. Valvular Heart Disease: Clinical
Presentation Number: 931–4
- 2013 American College of Cardiology Foundation