on June 30, 2003
Circulation. 2003
Published online before print June 30, 2003, doi: 10.1161/01.CIR.0000079171.43055.46
Published online before print June 30, 2003, doi: 10.1161/01.CIR.0000079171.43055.46
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Submitted on February 12, 2003
From the Departments of Cardiology, Henri Mondor Hospital, Créteil (J.-L.M., P.G.); University Hospital, Amiens (J.-P.Q., C.T.); General Hospital, Saint-Dizier (C.P.); General Hospital, Lorient (S.B., C.L.); Clinique Saint-Augustin, Bordeaux (C.C., P.D.); Department of Cardiac Surgery, University Hospital, Strasbourg, France (H.P., P.O.); and the Department of Intensive Care, University Hospital Sart Tilman, Liège, Belgium (M.M). * To whom correspondence should be addressed. E-mail: jeanluc.monin{at}free.fr.
Background--The prognostic value of dobutamine stress hemodynamic data in the setting of low-gradient aortic stenosis has been addressed in small, single-center studies. Larger studies are needed to define the criteria for selecting the patients who will benefit from valve replacement. Methods and Results--Six centers prospectively enrolled 136 patients with aortic stenosis (96 men; median age, 72 years [range, 65 to 77 years]; median aortic valve area, 0.7 cm2 [range, 0.6 to 0.8]; mean transaortic gradient, 29 mm Hg [range, 23 to 34 mm Hg]; cardiac index, 2.11 L · min-1 · m-2 [range, 1.75 to 2.55 L · min-1 · m-2]). Left ventricular contractile reserve on the dobutamine stress Doppler study was present in 92 patients (group I) and absent in 44 patients (group II). Operative mortality was 5% (3 of 64 patients) in group I compared with 32% (10 of 31 patients) in group II (P=0.0002). Predictors for operative mortality were the lack of contractile reserve (odds ratio, 10.9; 95% confidence interval [CI], 2.6 to 43.4; P=0.001) and a mean transaortic gradient Conclusions--In the setting of low-gradient aortic stenosis, surgery seems beneficial for most of the patients with left ventricular contractile reserve. In contrast, the postoperative outcome of patients without reserve is compromised by a high operative mortality. Thus, dobutamine stress Doppler hemodynamics may be factored into the risk-benefit analysis for each patient.
Revised on April 29, 2003
Accepted on May 2, 2003
Low-Gradient Aortic Stenosis. Operative Risk Stratification and Predictors for Long-Term Outcome: A Multicenter Study Using Dobutamine Stress Hemodynamics
Jean-Luc Monin MD*,
20 mm Hg (odds ratio, 4.7; 95% CI, 1.1 to 21.0; P=0.04). Predictors for long-term survival were valve replacement (hazard ratio, 0.30; 95% CI, 0.17 to 0.53; P=0.001) and left ventricular contractile reserve (hazard ratio, 0.40; 95% CI, 0.23 to 0.69; P=0.001).
Key words: valves • hemodynamics • surgery • cardiomyopathy • echocardiography
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