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(Circulation. 2000;101:1892.)
© 2000 American Heart Association, Inc.

Editorial

Severe Aortic Stenosis With Low Systolic Gradient

The Good and Bad News

Shahbudin H. Rahimtoola, MB, FRCP

From the Griffith Center, Division of Cardiology, Department of Medicine, Los Angeles County and University of Southern California Medical Center, Keck School of Medicine at USC, Los Angeles, Calif.

Key Words: Editorials • stenosis • valves • systole

Severe calcific aortic stenosis (AS) is an important clinical entity because (1) it is the most common valve lesion being considered for valve replacement in the United States,¹ especially in older people. (2) More people are living longer. In 1996, 36 million people in the United States were 65 years old, and by 2020, this number is expected to increase by 75%. (3) Aortic valve replacement (AVR) improves the survival of symptomatic patients.^{1 2} The relative survival of those 65 years old is better than those <65 years old.^{1 2} (4) The symptomatic state and abnormal LV function improve or normalize in most patients.^{1 2}

Patients with a mean aortic valve gradient (AVG) 30 mm Hg have been of concern. They may have severe AS even if left ventricular (LV) ejection fraction (EF) is normal. The clinical problem is magnified in those in whom LVEF is severely reduced because of uncertainty about the cause of low LVEF and patient outcome after AVR.

In this issue of Circulation, Connolly and coworkers³ from the Mayo Clinic present important data that clarify several issues but also raise other issues that need to be addressed. Of 52 patients 71±11 years old (mean±SD) with aortic valve area (AVA) of 0.7±0.2 cm², mean AVG <30 mm Hg, and LVEF <0.35, 86% were in NYHA functional classes III and IV. The good news is that after AVR, (1) the 3-year survival was 62%; (2) of the survivors, 47% were asymptomatic and 30% were minimally symptomatic (the improvement in . . . [Full Text of this Article]

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