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