Abstract 12310: Impact of Diastolic Dysfunction on Outcome in Patients With Low-Flow, Low-Gradient and Low Ejection Fraction Aortic Stenosis -Results From the TOPAS Study-
Background: Diastolic dysfunction (DD) is very common in patients with low-flow, low-gradient aortic stenosis (LF-LG AS) and low ejection fraction (EF). However, its impact on prognosis remains unknown in this condition. The aim of this study was to examine the impact of DD on all-cause mortality in this population of patients.
Methods: 215 patients (73±10 yrs; 77% men) with LF-LG AS and low EF (EF≤40%, mean gradient≤40 mmHg, and an Aortic Valve Area [AVA]≤0.6 cm2/m2) were included. The severity of AS was assessed by the projected AVA (AVAproj) at normal flow rate. Patients were separated in 2 groups according to the severity of DD: group1=patients with no or mild DD (abnormal relaxation pattern); group2=patients with moderate DD (pseudonormal pattern) or severe DD (restrictive pattern).
Results: Among the 215 patients, 162(75%) had assessment of diastolic function (DF). Due to atrial fibrillation, the assessment of DF was not available in the other patients. 90(56%) had no/mild DD (14 patients with no DD) and 72(44%) moderate/severe DD. 97(60%) patients underwent aortic valve replacement (AVR) within 3 months following inclusion. During a mean follow up of 2.4±2.2 yrs, 71(44%) patients died. Two-year survival was 75% in group1 and 55% in group2 (p=0.009). In multivariable Cox model adjusted for treatment (AVR vs. No AVR), age, gender, previous myocardial infarction, severity of AS, EF and stroke volume index, moderate/severe DD was independently associated with higher mortality (HR=2.26; 95% CI 1.23-4.17; p=0.008). After further adjustment for N-terminal pro-Brain Natriuretic Peptide level, moderate/severe DD remained an independent and powerful predictor of mortality (HR=3.63 95% CI 1.47-9.20; p=0.005). In the subgroup of pts. treated with AVR, those with moderate/severe DD had higher perioperative mortality compared to those with no/mild DD (8 [18.6%] vs. 2 [3.70%] deaths; p=0.02).
Conclusion: In this series of patients with LF-LG and Low EF AS, moderate-to-severe diastolic dysfunction was an independent and powerful predictor of all-cause mortality. It was also, closely associated to perioperative mortality. Thus, the assessment of diastolic function can be helpful for risk stratification and clinical decision making in this high risk population.
- © 2013 by American Heart Association, Inc.