The clinical management of patients with low gradient severe aortic stenosis (LG-SAS)
and preserved left ventricular ejection fraction (LVEF) remains challenging owing
to their heterogeneity. The aim to this study was to evaluate the relation between
an ejection dynamic parameter linked to AS severity and outcome, the ratio of acceleration
time (AT) to ejection time (ET), in a cohort of patients with LG-SAS and preserved
LVEF. Three hundred and fifty-six patients with LG-AS (defined by AVA ≤1 cm² and/or
AVAi ≤0.6 cm²/m² and mean aortic pressure gradient <40 mm Hg) and preserved LVEF ≥50%
were studied. The relation between AT/ET and all-cause and cardiac mortality during
follow-up was studied. Median follow-up was 41 months (interquartile range, 35 to
47 months). Median AT/ET was 0.32 (interquartile range, 0.29 to 0.36). The 5-year
estimates of all-cause and cardiac mortality were respectively 57 ± 7%, 36 ± 7% for
patients with AT/ET >0.36 versus 43 ± 4%, 16 ± 3% for patients with AT/ET ≤0.36 (p = 0.024 and p <0.001, respectively). After adjustment on known predictors
of outcome including aortic valve replacement used as a time-dependent covariate,
there was a significant increase in all-cause mortality risk for patients with AT/ET
>0.36 (adjusted hazard ratio 2.04 [95% confidence interval, 1.32 to 3.13]; p = 0.001)
and cardiac mortality risk (adjusted hazard ratio 2.89 [95% confidence interval, 1.54
to 5.43]; p<0.001) compared with patients with AT/ET ≤0.36. The association of AT/ET >0.36 and all-cause or cardiac mortality risk was consistent
in subgroups of patients with LG-SAS and preserved EF. In conclusion, an AT/ET ratio
of more than 0.36 is an independent predictor of mortality in patients with LG-SAS
and preserved EF.
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References
- 2017 ESC/EACTS Guidelines for the management of valvular heart disease.Eur Heart J. 2017; 38: 2739-2791
- Cardiac imaging for assessing low-gradient severe aortic stenosis.JACC Cardiovasc Imaging. 2017; 10: 185-202
- Paradox of low-gradient aortic stenosis.Circulation. 2019; 139: 2195-2197
- Ratio of acceleration time to ejection time for assessing aortic stenosis severity.Echocardiography. 2015; 32: 1754-1761
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography.J Am Soc Echocardiogr. 2017; 30: 372-392
- Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival.Circulation. 2007; 115: 2856
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39.e14
- Clinical significance of ejection dynamics parameters in patients with aortic stenosis: an outcome study.J Am Soc Echocardiogr. 2018; 31: 551-560.e2
- Low gradient aortic stenosis: who benefits from intervention?.JACC Cardiovasc Imaging. 2019; 12: 81-83
- Aortic valve replacement improves survival in severe aortic stenosis with gradient-area mismatch.Eur J Cardiothorac Surg. 2018; 53: 569-575
- Meta-analysis of outcomes of transcatheter aortic valve implantation among patients with low gradient severe aortic stenosis.Am J Cardiol. 2019; 124: 423-429
- 1-year survival after TAVR of patients with low-flow, low-gradient and high-gradient aortic valve stenosis in matched study populations.JACC Cardiovasc Interv. 2019; 12: 752-763
- Severe aortic stenosis patients with preserved ejection fraction according to flow and gradient classification: prevalence and outcomes.Int J Cardiol. 2017; 248: 211-215
- Low-gradient aortic stenosis: solving the conundrum using multi-modality imaging.Prog Cardiovasc Dis. 2018; 61: 416-422
- How do we reconcile echocardiography, computed tomography, and hybrid imaging in assessing discordant grading of aortic stenosis severity?.JACC Cardiovasc Imaging. 2019; 12: 267-282
- Computed tomography aortic valve calcium scoring in patients with aortic stenosis.Circ Cardiovasc Imaging. 2018; 11e007146
- Impact of stroke volume assessment by integrating multi-detector computed tomography and Doppler data on the classification of aortic stenosis.Int J Cardiol. 2017; 246: 80-86
- Preload stress echocardiography predicts outcomes in patients with preserved ejection fraction and low-gradient aortic stenosis.Circ Cardiovasc Imaging. 2017; 10
- Stress echocardiography to assess stenosis severity and predict outcome in patients with paradoxical low-flow, low-gradient aortic stenosis and preserved LVEF.JACC Cardiovasc Imaging. 2013; 6: 175-183
- Flow dynamics of stenotic aortic valves assessed by signal processing of Doppler spectrograms.Am J Cardiol. 2000; 85: 611-617
- Association of time between left ventricular and aortic systolic pressure peaks with severity of aortic stenosis and calcification of aortic valve.JAMA Cardiol. 2019; 4: 549-555
- Non-invasive assessment of aortic stenosis by Doppler ultrasound.Br Heart J. 1980; 43: 284-292
Article Info
Publication History
Published online: August 21, 2019
Received in revised form:
July 30,
2019
Received:
June 17,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
