Outcomes in Patients With Various Forms of Aortic Stenosis Including Those With Low-Flow Low-Gradient Normal and Low Ejection Fraction

Romero, Jorge; Chavez, Patricia; Goodman‐Meza, David; Holmes, Anthony A.; Ostfeld, Robert J.; Manheimer, Eric D.; Siegel, Robert; Lupercio, Florentino; Shulman, Eric; Liakos, Matthew; García, Mario J.; Spevack, Daniel M.

doi:10.1016/j.amjcard.2014.07.020

Cited by 20 publications

(20 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may cast further doubt as to whether low-flow severe AS with paradoxically preserved LVEF is a distinct clinical entity with worse prognosis. [3][4][5][6] Our cohort differed from cohorts of previous studies, being an Asian population, with a higher percentage of patients in the lowflow category. In fact, our study found that a significant proportion of patients with severe AS were low-flow (44% of patients with SVI <35 mL/m 2 ).…”

Section: Comparing Clinical Outcomes In Low-flow Vs Normal-flow Sevmentioning

confidence: 74%

“…However, the clinical outcomes of patients comparing low‐flow to normal‐flow were strikingly similar in our cohort. This may cast further doubt as to whether low‐flow severe AS with paradoxically preserved LVEF is a distinct clinical entity with worse prognosis …”

Section: Discussionmentioning

confidence: 99%

“…Several studies have identified clinical, biochemical, and echocardiographic factors associated with of morbidity and mortality in patients with severe AS . Beyond valve area, other factors such as reduced flow (LV stroke volume indexed to body surface area <35 mL/m 2 ) have been associated with severity of disease . In fact, in about 35% of patients with severe AS, there may be low‐flow AS despite preserved left ventricular ejection fraction (LVEF ≥50%) .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparing characteristics and clinical and echocardiographic outcomes in low‐flow vs normal‐flow severe aortic stenosis with preserved ejection fraction in an Asian population

et al. 2017

View full text Add to dashboard Cite

Background/Objectives In severe aortic stenosis (AS), deterioration of left ventricular ejection fraction (LVEF) to <50% is an AHA/ACC class I indication for valve replacement, regardless of symptoms. Controversy surrounds prognosis of low‐flow AS compared to normal‐flow, and no study has examined LVEF deterioration. We compared factors associated with LVEF deterioration (to <50%) and clinical outcomes. Methods Consecutive subjects with low‐flow (stroke volume index <35 mL/m2, n=56) and normal‐flow (n=72) severe AS (aortic valve area <1 cm2) with preserved LVEF (>50%) and with paired echocardiography were studied. Univariate and multivariate analyses identified factors associated with LVEF deterioration. Clinical outcomes were determined on follow‐up for more than 5 years. Results Significant LVEF deterioration (to <50%) was seen in 18% of low‐flow (initial LVEF 63±8% to 32±9%) and 18% of normal‐flow AS (61±7% to 31±12%). Independent factors in low‐flow AS were hypertension (OR: 30.7, 95% CI: 2.0–467.6, P=.014) and higher end‐systolic wall stress (OR: 1.086, 95% CI: 1.022–1.153, P=.008), compared to normal‐flow, which were hypertension (OR: 15.9, 95% CI: 3.1–81.9, P=.001), higher septal E/E′ ratio (OR: 1.16, 95% CI: 1.01–1.35, P=.043), lower septal S′ velocity (OR: 0.204, 95% CI: 0.061–0.682, P=.010), and higher end‐systolic wall stress (OR: 1.051, 95% CI: 1.001–1.104, P=.047). Overall, a third of the cohort experienced MACE, regardless of flow (log‐rank 0.048, P=.827). However, aortic valve replacement (AVR) rates were lower in low‐flow AS (20% vs 43%, P=.005). Conclusions Low‐flow AS despite normal LVEF appears similar to normal‐flow in terms of LVEF deterioration and clinical outcomes in our Asian population. AVR rate was lower even though low‐flow may not reflect less severe disease.

show abstract

Section: Comparing Clinical Outcomes In Low-flow Vs Normal-flow Sevmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparing characteristics and clinical and echocardiographic outcomes in low‐flow vs normal‐flow severe aortic stenosis with preserved ejection fraction in an Asian population

et al. 2017

View full text Add to dashboard Cite

show abstract

“…1 In several studies, reduced flow (LV stroke volume indexed to body surface area, SVI < 35 mL/m 2 ) despite preserved LV ejection fraction (EF ≥ 50%) has been demonstrated to be associated with poor prognosis and may represent more advanced disease. [2][3][4] However, other studies have contradicted these findings and suggested that the prognosis of low-flow patients is similar to their normal flow counterparts. 5 In addition, some studies have demonstrated that low-flow severe AS behaved more like moderate AS.…”

mentioning

confidence: 99%

Predicting changes in flow category in patients with severe aortic stenosis and preserved left ventricular ejection fraction on medical therapy

et al. 2017

View full text Add to dashboard Cite

Background/Objectives Controversy surrounds the prognosis and management of patients with paradoxical low‐flow severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF). It was not certain if patients in a particular flow category remained in the same category as disease progressed. We investigated whether there were switches in categories and if so, their predictors. Methods Consecutive subjects (n = 203) with isolated severe AS and paired echocardiography (>180 days apart) were studied. They were divided into 4 groups, based on their flow categories and if they progressed on subsequent echocardiography to switch or remain in the same flow category. Univariate analyses of clinical and echocardiographic parameters identified predictors of these changes in flow category. Results One hundred eighteen were normal flow (SVI ≥ 35 mL/m2), while 85 were low flow on index echocardiography. In the patients with normal flow, 33% switched to low flow. This was associated with higher valvuloarterial impedance (Zva, P < .001) and lower systemic arterial compliance (SAC, P < .001) compared to index echocardiography, and predicted by higher initial Zva (optimized cutoff >4.77 mm Hg/mL/m2, AUC = 0.81 [95% CI:0.75–0.87, P < .001]). In patients with low flow, 25% switched to normal flow, which was associated with lower Zva and higher SAC and the switch was predicted by a higher initial mean transaortic pressure gradient. Conclusions A significant number of patients switched flow categories in severe AS with preserved LVEF on subsequent echocardiography. Changes in flow were reflected by respective changes in Zva and SAC. Identifying echocardiographic predictors of a switch in category may guide prognostication and management of such patients.

show abstract

“…4 One of the factors independently associated with increased operative mortality is the presence of HF and reduced LVEF. 11,61,62 In a contemporary observational analysis including 114 135 patients aged ≥65 years who underwent isolated aortic valve replacement, the presence of HF was associated with increased operative mortality and worse long-term survival. 61 In addition, longer duration of HF symptoms before aortic valve replacement was significantly associated with worse outcome.…”

Section: Treatment and Outcomesmentioning

confidence: 99%

Diagnosis and management of aortic valve stenosis in patients with heart failure

Kamperidis

Delgado

Mieghem

et al. 2016

European J of Heart Fail

View full text Add to dashboard Cite

Aortic stenosis (AS) is the most frequent degenerative valvular heart disease in Western countries and its prevalence increases in parallel with the ageing process of the population. Heart failure (HF), defined by the presence of reduced left ventricular ejection fraction, may be present in up to a quarter of patients with severe AS, posing diagnostic and management challenges. The present article reviews the prevalence of HF in severe AS patients, discusses the diagnostic challenges and the advances in multimodality imaging to identify the patients that may benefit from surgical or transcatheter aortic valve replacement, and summarizes the current evidence on management for this group of patients.

show abstract

Outcomes in Patients With Various Forms of Aortic Stenosis Including Those With Low-Flow Low-Gradient Normal and Low Ejection Fraction

Cited by 20 publications

References 22 publications

Comparing characteristics and clinical and echocardiographic outcomes in low‐flow vs normal‐flow severe aortic stenosis with preserved ejection fraction in an Asian population

Comparing characteristics and clinical and echocardiographic outcomes in low‐flow vs normal‐flow severe aortic stenosis with preserved ejection fraction in an Asian population

Predicting changes in flow category in patients with severe aortic stenosis and preserved left ventricular ejection fraction on medical therapy

Diagnosis and management of aortic valve stenosis in patients with heart failure

Contact Info

Product

Resources

About