Flow-Gradient Patterns can help in the selection of patients with aortic stenosis

Original title: Flow-Gradient Patterns in Severe Aortic Stenosis UIT Preserved Ejection Fraction. Clinical Characteristic and Predictos of Survival. Reference: Eleid, M, et al. Circulation 2013;128:1781-1789

Severe aortic stenosis is usually defined by echocardiography as a 40 mm mean transvalvular gradient Hg at >4 m/s; but there are low flow or paradoxical low flow cases with different evolution.

1704 AS patients were divided in 4 groups: low flow/high gradient (LF/HG) n= 50 (3%), low flow/low gradient (LF/LG) n= 53 (3%), normal flow/low gradient (NF/LG) n= 352 (21%) and normal flow/high gradient (NF/HG) n= 1249 (73%).

The less symptomatic was the NF/LG) group, characterized by a high prevalence of women, less, smaller LV cavity and restrictive filling pattern. The LF/LG group presented the most deteriorated LVEF, also the lowest LV mass index, the smallest LV diameter and the greatest incidence of auricular fibrillation.

62% of all patients received surgical AVR and 4% received TAVR. NF/LG patients mostly received medical management, with favorable survival of 59% at 2 years.

The LF/LG group had the worst prognosis, with 60% survival rate at 2 years. Survival rate was 85% for the NF/LG group, 82% for the NF/HG group and 78% for the LF/LG group (p<0.0001 was the difference in survival between groups).  Aortic valve replacement (AVR) was associated with a 69% mortality reduction in LF/LG and NF/HG groups.

Conclusion:

NF/LG severe AS with preserved EF exhibits favorable survival with medical management and impact of AVR on survival was neutral. LF/LG was associated with higher mortality and TAVR was associated with improved survival. 

Editorial Comment

This new way of classifying AS offers important information about prognosis. It would be preferable to start using it on a daily basis, especially with high risk patients that most frequently pose the greatest challenges as regards strategy.

Courtesy of Dr Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation. Argentina.

Dr. Carlos Fava para SOLACI.ORG

More articles by this author

Prospective Analysis of the Feasibility of the PASCAL System for Transcatheter Mitral Repair: OneForAll Registry

Courtesy of Dr. Juan Manuel Pérez. Mitral transcatheter edge-to-edge repair (M-TEER) is an effective option for patients with severe mitral regurgitation who are at high...

Left Bundle Branch Block after TAVR: What Is Its Impact?

Courtesy of Dr. Juan Manuel Pérez. Left bundle branch block (LBBB) is a common complication following transcatheter aortic valve replacement (TAVR), which can be either...

Multicenter Experience with 3D Intracardiac Echocardiography for Guiding Interventional Cardiac Procedures

Courtesy of Dr. Juan Manuel Pérez. Imaging techniques play a fundamental role in interventional cardiac procedures. Intracardiac echocardiography (ICE) appears as an alternative to transesophageal...

Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening

Courtesy of Dr. Juan Manuel Pérez. Despite the available long term followup data on of transcatheter aortic valve replacement (TAVR), bioprosthesis durability continues under debate....

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...