Prognosis of Paradoxical Low-Flow Low-Gradient Aortic Stenosis : A Severe, Non-critical Form, With Surgical Treatment Benefits
Galian-Gay, Laura (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Escalona Silva, Roxana Andreina (Hospital Universitari Vall d'Hebron)
Teixido-Tura, Gisela (Hospital Universitari Vall d'Hebron)
Casas, Guillem (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ferrer-Sistach, Elena (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Mitroi, Cristina (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Mingo, Susana (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Monivas, Vanessa (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Saura, Daniel (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))
Vidal, Bàrbara (Hospital Clínic i Provincial de Barcelona)
Trasca, Livia (Hospital Clínic i Provincial de Barcelona)
Moral Torres, Sergio (Hospital Universitari de Girona Doctor Josep Trueta)
Calvo Iglesias, Francisco (Hospital Álvaro Cunqueiro (Vigo))
Castiñeira Busto, Maria (Hospital Álvaro Cunqueiro (Vigo))
Sánchez, Violeta (Hospital Universitario 12 de Octubre (Madrid))
Gonzalez, Ariana (Hospital Universitario Ramón y Cajal (Madrid))
Guzman, Gabriela (Hospital Universitario La Paz (Madrid))
Mora, Marta Noris (Institut d'Investigació Sanitària Illes Balears)
Arnau Vives, Miguel Ángel (Hospital Universitari i Politècnic La Fe (València))
Peteiro, Jesús (Complejo Hospitalario Universitario de A Coruña)
Bouzas, Alberto (Complejo Hospitalario Universitario de A Coruña)
Mas-Stachurska, Aleksandra (Hospital del Mar (Barcelona, Catalunya))
González-Alujas, Teresa (Hospital Universitari Vall d'Hebron)
Gutiérrez García-Moreno, Laura (Hospital Universitari Vall d'Hebron)
Fernandez-Galera, Rubén (Hospital Universitari Vall d'Hebron)
Valente, Filipa (Hospital Universitari Vall d'Hebron)
Guala, Andrea (Hospital Universitari Vall d'Hebron)
Ruiz-Muñoz, Aroa (Hospital Universitari Vall d'Hebron)
Sao-Avilés, Augusto (Hospital Universitari Vall d'Hebron)
Rodriguez-Palomares, Jose F (Hospital Universitari Vall d'Hebron)
Ferreira-Gonzalez, Ignacio (Hospital Universitari Vall d'Hebron)
Evangelista, Artur (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Data:	2022
Resum:	To determine the risk of mortality and need for aortic valve replacement (AVR) in patients with low-flow low-gradient (LFLG) aortic stenosis (AS). A longitudinal multicentre study including consecutive patients with severe AS (aortic valve area [AVA] < 1. 0 cm 2) and normal left ventricular ejection fraction (LVEF). Patients were classified as: high-gradient (HG, mean gradient ≥ 40 mmHg), normal-flow low-gradient (NFLG, mean gradient < 40 mmHg, indexed systolic volume (SVi) > 35 ml/m 2) and LFLG (mean gradient < 40 mmHg, SVi ≤ 35 ml/m 2). Of 1,391 patients, 147 (10. 5%) had LFLG, 752 (54. 1%) HG, and 492 (35. 4%) NFLG. Echocardiographic parameters of the LFLG group showed similar AVA to the HG group but with less severity in the dimensionless index, calcification, and hypertrophy. The HG group required AVR earlier than NFLG (p < 0. 001) and LFLG (p < 0. 001), with no differences between LFLG and NFLG groups (p = 0. 358). Overall mortality was 27. 7% (CI 95% 25. 3-30. 1) with no differences among groups (p = 0. 319). The impact of AVR in terms of overall mortality reduction was observed the most in patients with HG (hazard ratio [ HR ]: 0. 17; 95% CI : 0. 12-0. 23; p < 0. 001), followed by patients with LFLG (HR : 0. 25; 95% CI : 0. 13-0. 49; p < 0. 001), and finally patients with NFLG (HR : 0. 29; 95% CI : 0. 20-0. 44; p < 0. 001), with a risk reduction of 84, 75, and 71%, respectively. Paradoxical LFLG AS affects 10. 5% of severe AS, and has a lower need for AVR than the HG group and similar to the NFLG group, with no differences in mortality. AVR had a lower impact on LFLG AS compared with HG AS. Therefore, the findings of the present study showed LFLG AS to have an intermediate clinical risk profile betwee the HG and NFHG groups.
Ajuts:	Ministerio de Ciencia e Innovación IJC2018- 037349-I
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Aortic stenosis ; Paradoxical low-flow low-gradient ; Echocardiography ; Aortic valve surgery ; Heart valve disease
Publicat a:	Frontiers in Cardiovascular Medicine, Vol. 9 (april 2022) , ISSN 2297-055X

DOI: 10.3389/fcvm.2022.852954
PMID: 35433871

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