Abstract
Long and mid-term data in Low-Flow Low-Gradient Aortic Stenosis (LFLG-AS) are scarce. The present study sought to identify predictors of outcome in a sizeable cohort of patients with LFLG-AS. 76 consecutive patients with LFLG-AS (defined by a mean gradient <40 mmHg, an aortic valve area ≤1 cm2 and an ejection fraction ≤50%) were prospectively enrolled and followed at regular intervals. Events defined as aortic valve replacement (AVR) and death were assessed and overall survival was determined. 44 patients underwent AVR (10 transcatheter and 34 surgical) whilst intervention was not performed in 32 patients, including 9 patients that died during a median waiting time of 4 months. Survival was significantly better after AVR with survival rates of 91.8% (CI 71.1–97.9%), 83.0% (CI 60.7–93.3%) and 56.3% (CI 32.1–74.8%) at 1,2 and 5 years as compared to 84.3% (CI 66.2–93.1%), 52.9% (CI 33.7–69.0%) and 30.3% (CI 14.6–47.5%), respectively, for patients managed conservatively (p = 0.017). The presence of right ventricular dysfunction (HR 3.47 [1.70–7.09]) and significant tricuspid regurgitation (TR) (HR 2.23 [1.13–4.39]) independently predicted overall mortality while the presence of significant TR (HR 3.40[1.38–8.35]) and higher aortic jet velocity (HR 0.91[0.82–1.00]) were independent predictors of mortality and survival after AVR. AVR is associated with improved long-term survival in patients with LFLG-AS. Treatment delays are associated with excessive mortality, warranting urgent treatment in eligible patients. Right ventricular involvement characterized by the presence of TR and/or right ventricular dysfunction, identifies patients at high risk of mortality under both conservative management and after AVR.
Highlights
Severe symptoms, coronary artery disease (CAD), severe LV dysfunction; absence of LV flow reserve on DSE, B-type natriuretic peptides and myocardial fibrosis have been identified as predictors of adverse outcomes9
While the mechanism of mitral regurgitation (MR) was secondary in all cases, additional degenerative changes were present in the majority www.nature.com/scientificreports of patients. 6 patients had additional degenerative calcification of the mitral apparatus with a mild-to-moderate stenotic effect. 51 pts had mild-to-moderate tricuspid regurgitation (TR) and moderate-to-severe TR was present in 15 patients
We previously demonstrated that serial follow-up visits in HVCs might encourage patients who initially refused a valve intervention to reconsider their decision18
Summary
Coronary artery disease (CAD), severe LV dysfunction; absence of LV flow reserve on DSE, B-type natriuretic peptides and myocardial fibrosis have been identified as predictors of adverse outcomes. LFLG-AS constitutes an advanced disease stage, it is frequently associated with mitral regurgitation (MR), tricuspid regurgitation (TR) and RV dysfunction. Recent data indicate a potential predictive value of TR10 and right ventricular dysfunction (RVD). The aim of the present study was to assess the predictive value of RVD, TR and MR on the long-term outcome of patients with LFLG-AS
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
