Outcome of Normal‐Flow Low‐Gradient Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction: A Propensity‐Matched Study
Key result
Normal-flow low-gradient severe AS carries similar mortality risk to moderate AS.
Why the study?
The true severity and clinical management of normal-flow, low-gradient severe aortic stenosis remain controversial.
Does normal-flow low-gradient severe aortic stenosis increase mortality compared to moderate aortic stenosis or high-gradient severe aortic stenosis?
Population
154 patients with NF-LG-SAS, 366 with MAS, and 1055 with HG-SAS
Comparison
NF-LG-SAS vs MAS vs HG-SAS
Design
Propensity-matched observational cohort study
Authors
Discussion
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Member takes
Implication
NF-LG-SAS associated with mortality similar to moderate AS; extends observational data but leaves optimal management open pending RCTs.
Structured PICO
Does normal-flow low-gradient severe aortic stenosis increase mortality compared to moderate aortic stenosis or high-gradient severe aortic stenosis?
P
Population
1,575 adults with aortic stenosis and preserved LVEF (≥50%), including 154 with normal-flow low-gradient severe AS (NF-LG-SAS), 366 with moderate AS (MAS), and 1,055 with high-gradient severe AS (HG-SAS). Excluded: more than mild aortic and/or mitral regurgitation, prosthetic valves, congenital heart disease, supravalvular or subvalvular AS, dynamic LV outflow tract obstruction, and LVEF <50%.
I
Intervention
Normal-flow, low-gradient severe aortic stenosis (NF-LG-SAS) diagnosis (observational exposure)
C
Comparator
Moderate aortic stenosis (MAS) and high-gradient severe aortic stenosis (HG-SAS)
O
Outcome
Overall survival after diagnosis at baseline echocardiographyhard clinical
Patients with normal-flow, low-gradient severe aortic stenosis have comparable survival outcomes to those with moderate aortic stenosis, suggesting they should be managed similarly and highlighting the importance of ruling out echocardiographic measurement errors.
Limitations
- Retrospective nature of follow-up information collection
Cite This Study
Chadha et al. (2019) studied this question. Patients with normal-flow low-gradient severe aortic stenosis had comparable mortality risk to moderate aortic stenosis patients, with hazard ratios around 1.06 under various management strategies.