Eiji Yamashita1, Masaaki Takeuchi2, Yoshihiro Seo3, Masaki Izumo4, Tomoko Ishizu3, Kimi Sato3, Kengo Suzuki4, Yoshihiro J Akashi4, Kazutaka Aonuma3, Yutaka Otsuji5, Shigeru Oshima1. 1. Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. 2. Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan. Electronic address: takeuchi@med.uoeh-u.ac.jp. 3. Cardiovascular Division, University of Tsukuba, Tsukuba, Japan. 4. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan. 5. Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Abstract
BACKGROUND: Whether the prognosis of paradoxical low-gradient severe aortic stenosis (PLG-SAS), especially due to paradoxical low-flow low-gradient SAS (PLFLG-SAS), is malignant in any specific ethnicity, including Japanese, remains unclear. METHODS: We retrospectively enrolled 385 consecutive Japanese patients (age, 76±8 years; 148 men) with moderate AS [MAS: 0.6≤indexed aortic valve area (iAVA)<0.85cm(2)/m(2)] or SAS (iAVA <0.6cm(2)/m(2)) with preserved left ventricular ejection fraction (≥50%). SAS patients were divided into PLG-SAS and high-gradient (HG)-SAS according to the transvalvular mean gradient (40mmHg). PLG-SAS was categorized into 2 groups: normal-flow (NF) LG-SAS [stroke volume index (SVi) ≥35mL/m(2)] and PLFLG-SAS (SVi <35mL/m(2)). Endpoints were all-cause death and major adverse cardio-cerebrovascular events (MACE). RESULTS: During a median follow-up of 15 months, 31 patients died and 48 suffered MACE. All-cause death and MACE rates in PLG-SAS and PLFLG-SAS were significantly lower than those in HG-SAS and similar to those in MAS. On multivariate analysis, neither PLG-SAS nor PLFLG-SAS were independent determinants for all-cause death compared with MAS [MAS as reference, PLG-SAS: hazard ratio (HR) 0.47, p=0.32; PLFLG-SAS: HR 0.01, p=0.20; HG-SAS: HR 3.37, 95% confidence interval 1.24-9.74, p=0.02]. CONCLUSIONS: In Japanese patients, the prognoses of PLG-SAS and PLFLG-SAS were better than that of HG-SAS and similar to that of MAS, being better than that in Western populations.
BACKGROUND: Whether the prognosis of paradoxical low-gradient severe aortic stenosis (PLG-SAS), especially due to paradoxical low-flow low-gradient SAS (PLFLG-SAS), is malignant in any specific ethnicity, including Japanese, remains unclear. METHODS: We retrospectively enrolled 385 consecutive Japanese patients (age, 76±8 years; 148 men) with moderate AS [MAS: 0.6≤indexed aortic valve area (iAVA)<0.85cm(2)/m(2)] or SAS (iAVA <0.6cm(2)/m(2)) with preserved left ventricular ejection fraction (≥50%). SAS patients were divided into PLG-SAS and high-gradient (HG)-SAS according to the transvalvular mean gradient (40mmHg). PLG-SAS was categorized into 2 groups: normal-flow (NF) LG-SAS [stroke volume index (SVi) ≥35mL/m(2)] and PLFLG-SAS (SVi <35mL/m(2)). Endpoints were all-cause death and major adverse cardio-cerebrovascular events (MACE). RESULTS: During a median follow-up of 15 months, 31 patients died and 48 suffered MACE. All-cause death and MACE rates in PLG-SAS and PLFLG-SAS were significantly lower than those in HG-SAS and similar to those in MAS. On multivariate analysis, neither PLG-SAS nor PLFLG-SAS were independent determinants for all-cause death compared with MAS [MAS as reference, PLG-SAS: hazard ratio (HR) 0.47, p=0.32; PLFLG-SAS: HR 0.01, p=0.20; HG-SAS: HR 3.37, 95% confidence interval 1.24-9.74, p=0.02]. CONCLUSIONS: In Japanese patients, the prognoses of PLG-SAS and PLFLG-SAS were better than that of HG-SAS and similar to that of MAS, being better than that in Western populations.
Authors: Yan Fan; Hong Shen; Brandon Stacey; David Zhao; Robert J Applegate; Neal D Kon; Edward H Kincaid; Sanjay K Gandhi; Min Pu Journal: Int J Cardiovasc Imaging Date: 2021-08-14 Impact factor: 2.357