Abstract 12382: Short And Long-term Outcome And Benefit Of Surgery In Patients With Low Flow, Low Gradient Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction: Results From A Cardiac Catheterization-based Study
Background: The exact prevalence, characteristics and impact on short and long-term outcome of low flow, low gradient severe aortic stenosis (LFLG) despite preserved left ventricular ejection fraction (LVEF), remains debatable.The aim of our study is to describe the outcome of patients with LFLG AS using cardiac catheterization data.
Methods and Results: Between 2000 and 2010, 770 patients with preserved LVEF (>50%) and severe AS (valve area <1cm²) without other valvular heart disease having underwent cardiac catheterization, were retrospectively analyzed. Mean age was 74±8 years, 42% were female, 46% had associated coronary artery disease. LFLG (indexed LV stroke volume<35mL/m² and mean gradient<40mm Hg) were found in 13% of patients (n=99), normal flow high gradient (NFHG) in 50% (n=388), LFHG in 14% and NFLG in 23%. In comparison with classical patients with NFHG, those with LFLG were significantly older, and more often female. The hemodynamic data including the systemic compliance, vascular systemic resistances and valvulo-arterial impedance were significantly impaired in LFLG patients as compared to those with NFHG. Thirty-days mortality was higher in patients with LFLG when compared to NFHG (9 vs. 4%, p=0.06) and 10-year survival was significantly reduced in LFLG (32±8%) when compared to NFHG (66±4%; p=0.0005) (figure). Furthermore, after adjustment for confounding factors including the propensity score, multivariate analysis show LFLG AS was independently associated with reduced long-term survival: HR= 2.02; 95 CI:(1.31-3.15) p=0.002. Patients who underwent AVR had significantly better long-term survival than those who were managed medically (70 pts) (all p<0.001) in all groups of AS patients irrespective of the gradient or flow.
Conclusion: Our cardiac catheterization-based study confirms LFLG severe AS is a frequent entity associated with poor short- and long-term outcome. Moreover, AVR seems to be a beneficial, even in LFLG pts.
- © 2012 by American Heart Association, Inc.