Sahrai Saeed1,2,3, Anastasia Vamvakidou1,2, Reinhard Seifert3, Rajdeep Khattar1,4, Wei Li1, Roxy Senior1,2,4. 1. Department of Echocardiography, Royal Brompton Hospital, London, UK. 2. Northwick Park Hospital, Harrow, UK. 3. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. 4. National Heart and Lung Institute, Imperial College, London, UK.
Abstract
AIMS: To assess the survival benefit of aortic valve replacement (AVR) in patients with normal flow low gradient severe aortic stenosis (AS). METHODS AND RESULTS: A retrospective study of prospectively collected data of 276 patients (mean age 75 ± 15 years, 51% male) with normal transaortic flow [flow rate (FR) ≥200 mL/s or stroke volume index (SVi) ≥35 mL/m2] and severe AS (aortic valve area <1.0 cm2). The outcome measure was all-cause mortality. Of the 276 patients, 151 (55%) were medically treated, while 125 (45%) underwent an AVR. Over a mean follow-up of 3.2 ± 1.8 years (range 0-6.9 years), a total of 96 (34.8%) deaths occurred: 17 (13.6%) in AVR group vs. 79 (52.3%) in those medically treated, when transaortic flow was defined by FR (P < 0.001). When transaortic flow was defined by SVi, a total of 79 (31.3%) deaths occurred: 18 (15.1%) in AVR group vs. 61 (45.9%) in medically treated (P < 0.001). In a propensity-matched multivariable Cox regression analysis adjusting for age, gender, body surface area, smoking, hypertension, diabetes mellitus, atrial fibrillation, peripheral vascular disease, chronic kidney disease, left ventricular ejection fraction, left ventricular mass, and mean aortic gradient, not having AVR was associated with a 6.3-fold higher hazard ratio (HR) of all-cause mortality [HR 6.28, 95% confidence interval (CI) 3.34-13.16; P < 0.001] when flow was defined by FR. In the SVi-guided model, it was 3.83-fold (HR 3.83, 95% CI 2.30-6.37; P < 0.001). CONCLUSION: In patients with normal flow low gradient severe AS, AVR was associated with a significantly improved survival compared with those who received standard medical treatment. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To assess the survival benefit of aortic valve replacement (AVR) in patients with normal flow low gradient severe aortic stenosis (AS). METHODS AND RESULTS: A retrospective study of prospectively collected data of 276 patients (mean age 75 ± 15 years, 51% male) with normal transaortic flow [flow rate (FR) ≥200 mL/s or stroke volume index (SVi) ≥35 mL/m2] and severe AS (aortic valve area <1.0 cm2). The outcome measure was all-cause mortality. Of the 276 patients, 151 (55%) were medically treated, while 125 (45%) underwent an AVR. Over a mean follow-up of 3.2 ± 1.8 years (range 0-6.9 years), a total of 96 (34.8%) deaths occurred: 17 (13.6%) in AVR group vs. 79 (52.3%) in those medically treated, when transaortic flow was defined by FR (P < 0.001). When transaortic flow was defined by SVi, a total of 79 (31.3%) deaths occurred: 18 (15.1%) in AVR group vs. 61 (45.9%) in medically treated (P < 0.001). In a propensity-matched multivariable Cox regression analysis adjusting for age, gender, body surface area, smoking, hypertension, diabetes mellitus, atrial fibrillation, peripheral vascular disease, chronic kidney disease, left ventricular ejection fraction, left ventricular mass, and mean aortic gradient, not having AVR was associated with a 6.3-fold higher hazard ratio (HR) of all-cause mortality [HR 6.28, 95% confidence interval (CI) 3.34-13.16; P < 0.001] when flow was defined by FR. In the SVi-guided model, it was 3.83-fold (HR 3.83, 95% CI 2.30-6.37; P < 0.001). CONCLUSION: In patients with normal flow low gradient severe AS, AVR was associated with a significantly improved survival compared with those who received standard medical treatment. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Mayooran Namasivayam; Wei He; Timothy W Churchill; Romain Capoulade; Shiying Liu; Hang Lee; Jacqueline S Danik; Michael H Picard; Philippe Pibarot; Robert A Levine; Judy Hung Journal: J Am Coll Cardiol Date: 2020-04-21 Impact factor: 24.094
Authors: Laura Galian-Gay; Roxana Andreina Escalona Silva; Gisela Teixidó-Turà; Guillem Casas; Elena Ferrer-Sistach; Cristina Mitroi; Susana Mingo; Vanessa Monivas; Daniel Saura; Bàrbara Vidal; Livia Trasca; Sergio Moral; Francisco Calvo; Maria Castiñeira Busto; Violeta Sánchez; Ariana Gonzalez; Gabriela Guzman; Marta Noris Mora; MiguelÁngel Arnau Vives; Jesús Peteiro; Alberto Bouzas; Aleksandra Mas-Stachurska; Teresa González-Alujas; Laura Gutiérrez; Rubén Fernandez-Galera; Filipa Valente; Andrea Guala; Aroa Ruiz-Muñoz; Cesar Augusto Sao Avilés; José F Rodríguez Palomares; Ignacio Ferreira; Artur Evangelista Journal: Front Cardiovasc Med Date: 2022-04-01