Abstract 10027: The Prognosis of Patients with Severe Isolated Aortic Stenosis (AS), Low Transvalvular Gradients (TVG) and Preserved Left Ventricular (LV) Ejection Fraction (EF); One Center Experience
Objective: Severe AS with preserved EF and low transvalvular gradients (TVG) has become lately recognized as an important entity of AS with specific pathophysiologic and prognostic characteristics. We sought to determine the relative long term prognosis of a large group of patients (pts) with severe AS, preserved EF, and mean TVG <30 mm Hg which is a lower value than that chosen in the majority of published studies.
Methods: 560 pts (27% prospectively enrolled) who had at transthoracic echocardiogram severe isolated AS (mean age = 78.5 ± 10.2 years, 50% men, in sinus rhythm) were divided in 2 groups, based on a mean TVG threshold of 30 mm Hg. Mean follow-up = 36 ± 32 months. All the measurements were done off-line on a dedicated echo reading station. Kaplan-Meier and Cox proportional hazards regression was used to test survival controlling for AVA index and systemic vascular resistance.
Results: (see table) 306 pts (55%) underwent AV replacement (AVR) of whom 137 (25%) died before and 55 pts (10%) died after surgery. For the 220 pts (45%) who did not undergo AVR, the unadjusted and adjusted hazard ratios for death of MG ≥ 30 mm Hg were 0.74, (95% CI, 0, 54 - 0.99) and 0.60 (95% CI, 0.40-0.92) respectively.
Conclusions: 1. In this study, 26% of pts with isolated severe AS and normal EF had a MG < 30 mm Hg and they were less referred to AVR than the high TVG group. 2. By survival curves analyses, a mean TVG < 30 mm Hg is associated with a worse prognosis and such pts should be closely followed.
- © 2012 by American Heart Association, Inc.