Objective Among patients with severe aortic stenosis (sAS) and preserved LVEF, those with low-flow, low-gradient sAS (LFLG-sAS) have an adverse prognosis. It has been proposed that LFLG-sAS represents an end-stage point of sAS, but longitudinal information has not been described. The aim was to determine whether LFLG-sAS represents an end-stage consequence of normal-flow, high-gradient sAS (NFHG-sAS) or a different entity.
Methods From our transthoracic echocardiogram (TTE) database, we identified patients with sAS (aortic valve area <1 cm2) and preserved LVEF (≥50%), and from these, patients with LFLG-sAS (stroke volume index <35 mL/m2 and mean transvalvular gradient <40 mm Hg) who had ≥1 additional TTE within five years prior to the index TTE. Patients were age/sex/date matched 2:1 with patients with NFHG-sAS and normal-flow, low-gradient (NFLG)-sAS who also had ≥1 TTE. Included were 1203 TTEs (383 index studies and 820 preceding studies).
Results In 78 patients with LFLG-sAS, an HG stage preceded the index TTE in only 4 (5%). During the five years preceding the index TTE, patients with LFLG-sAS developed increasing relative wall thickness (0.42 to 0.49; p<0.001) without change in LV mass index. Patients with NFHG-sAS had a marked increase in LV mass index (87 to 115 g/m2; p<0.001). Patients with LFLG-sAS demonstrated the greatest reduction in LV end-diastolic diameters (−3 vs −1 for NFLG-sAS vs +2 mm for NFHG-sAS; p=0.001), deceleration time (−55 vs −3 vs +3 ms, respectively; p<0.01) and LVEF (−4 vs 0 vs 0%, respectively; p=0.01).
Conclusions LFLG-sAS is a distinct presentation of sAS preceded by a unique remodelling pathway and is uncommonly preceded by an HG stage.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.