Abstract 12648: Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction: Impact of Transaortic Flow, Transaortic Gradient and Age on Outcomes
Background: Combining transaortic flow and gradient defined four different aortic stenosis (AS) subgroups. The impact of transaortic flow and gradient and age on predicting the outcomes of severe AS with preserved ejection fraction (EF) is not well defined.
Methods: We identified consecutive patients presenting to our echo lab with an aortic valve area (AVA) < 1.0cm2 and EF≥ 50%. We stratify patients depending on gradient (≥ 40 vs. < 40 mmHg) and stroke volume index (SVI < 35 vs. ≥35 ml/m2). 4 groups were identified (, normal flow, high gradient [NF/HG]; normal flow, low gradient [NF/LG]; low flow, high gradient [LF/HG] and low flow, low gradient [LF/LG]. These 4 groups were also stratified depending on age (Age < 75 vs. ≥75 years). All patients were retrospectively followed for the occurrence of death.
Results: A total of 954 patients were included in analysis. Mean follow up was 2.45 ± 1.9 years. The mean age was 75.4 ± 5.6 years. Patients with LF had significant higher mortality than those with NF [32.6% vs. 25.8%; HR=1.39 (1.04-1.86); P=0.03]. Similarly, patients with HG had significant higher mortality than those LG [34.9% vs. 25.7%; HR=1.55 (1.17-2.06); P<0.01]. Comparing all 4 AS subgroups, the mortality was higher in LF/HG followed by LF/LG, NF/HG and NF/LG (LF/HG 37.1% vs. LF/LG 33.9% vs. NF/HG 30.3%vs. NF/LG 20.2%; Log Rank Test, P=0.003). Older patients have a higher mortality rate than younger patients. [31.1% vs. 22.5%; HR= 1.55 (1.1-2.19); P= 0.01]. In Patients older than 75, comparing all 4 AS subgroups, the mortality was higher in LF/HG followed by LF/LG, NF/HG and NF/LG (LF/HG 37.9% vs. LF/LG 37.8% vs. NF/HG 35.0% vs. NF/LG 19.6%; %; Log Rank Test, P=0.003). Comparing the 4 flow-gradient groups in patients younger than 75 shows a similar, but not significant trend with the mortality is higher in LF/HG followed by LF/LG, NF/HG and NF/LG (LF/HG 32.4% vs. LF/LG 30.7% vs. NF/HG 25.8% vs. NF/LG 9.6%; Log Rank Test, P=0.058).
Conclusion: Combining transaortic flow and gradient is essential in in predicting prognosis in severe aortic stenosis with preserved EF. Age add an incremental value to transaortic gradient and flow in predicting prognosis.
Author Disclosures: Z. Fanari: None. D. Barmpouletos: None. V.K. Reddy: None. S. Hammami: None. Z. Zhang: None. W.S. Weintraub: None. E.S. Marshall: None.
- © 2015 by American Heart Association, Inc.