Abstract 3957: Is Paradoxical Low Gradient Severe Aortic Stenosis With Preserved Ejection Fraction Associated With a Poor Prognosis in Elderly Patients?
Backgound: Recent data suggest that low gradient severe aortic stenosis (AS) with preserved ejection fraction, sometimes referred to “paradoxical low flow low gradient AS (PLGAS), is associated with a poor long term outcome when not managed surgically. The aim of this study was to verify this hypothesis.
Methods: Betweeen 2000 and 2007, 819 patients aged >75 years were identified as having severe AS (aortic valve area ≤1 cm2) in our echolab database. Among these, 153 (18%, mean age 84±6 years, 28% males) were found to have PLGAS, defined as an valve area ≤1 cm2, a mean gradient <30 mmHg and a normal EF. After exclusion of pts whose life expectancy was <1 year because of concomitant life-threatening co-morbidities (n=20) and those who underwent aortic valve replacement within 3 months of the index diagnosis (n=14), the final study group consisted of 114 pts (mean age: 84±6 years, 27% of males) whose survival was compared with that of the age and gender matched Belgian population.
Results: Baseline characteristics of our study group were: mean transaortic pressure difference: 22±6 mmHg, mean aortic valve was: 0.5±0.1 cm2/m2, LV end-diastolic dimensions: 48±6 mm, LV end-systolic dimensions: 30±5 mm, mean EF: 68±9%. During a mean follow-up of 3.2±2.2 years, 38 pts died. The overall 5-year survival of PLGAS pts was 61% whereas that of the age and gender matched Belgian population was 52% (Figure⇓)
Conclusion: Our data show that PLGAS is common in elderly pts with severe AS. Our data also show that the spontaneous prognosis of PLGAS pts is not as poor as previously reported. Caution should thus be exercised before contemplating aortic valve replacement in these pts.