Abstract 10661: Prognostic Value of Paradoxical Low-flow low-pressure Gradient Severe Aortic Stenosis in Japanese Population: Japanese Multicenter Aortic Stenosis, Retrospective study (JUST-R)
Background: Although paradoxical low-flow low-gradient severe aortic stenosis (PLFLG-SAS) is associated with poor prognosis in the Europe and North America, it is not known whether it is also true in Asian countries.
Methods: A total of 524 consecutive patients (77±8 years, 185 male) with severe AS (indexed aortic valve area 50%) were retrospectively enrolled from 4 Japanese hospitals. Patients were divided into 4 groups (NFHPG: stroke volume index (SVI)≥35ml/m2 and mean pressure gradient (mPG)≥40mmHg, NFLPG: SVI≥35ml/m2 and mPG<40mmHg, LFHPG: SVI<35ml/m2 and mPG≥40mmHg and LFLPG group: SVI<35ml/m2 and mPG<40mmHg) according to mPG of aortic valve and SVI. Cardiac death (CD) and major adverse cardio-cerebrovascular event (MACE), including CD, non-fetal myocardial infarction, admission for heart failure and aortic valve replacement were determined.
Results: A total of 218 patients (42%) were classified into LFLPG group. During a mean of 454 days of follow up, 29 patients had CD and 214 had MACE. Kaplan-Meier analysis revealed that LFLPG had lowest CD and MACE rate compared to other 3 groups. On multivariate analysis, LFLPG was a strong independent negative determinants of CD compared with any other groups. (LFLPG as a reference, NFLPG: Hazard ratio (HR) 4.69, 95% confidence interval (CI) 1.29-21.9, P=0.018, NFHPG: HR 4.77, 95% CI 1.09-25.9, P=0.038, LFHPG: HR 9.36, 95% CI 2.23-49.4, P=0.002).
Conclusions: Although PLFLG-SAS was frequently observed in Japanese AS patients, their prognosis was better than other 3 hemodynamically stratified groups. These results suggest that racial differences could be the potential impact on pathophysiology and prognosis in PLFLG-SAS.
- © 2013 by American Heart Association, Inc.