Paradoxical low-flow, low-gradient aortic stenosis was associated with increased all-cause mortality after TAVI compared to classical high-gradient aortic stenosis (HR 1.43; 95% CI 1.06-1.92).
Cohort (n=880)
No
Does paradoxical low-flow, low-gradient aortic stenosis increase mortality and heart failure readmissions compared to classical high-gradient aortic stenosis in patients undergoing TAVI?
Patients with paradoxical low-flow, low-gradient aortic stenosis represent a high-risk group with higher mortality and heart failure readmissions after TAVI compared to those with classical high-gradient aortic stenosis.
Hazard Ratio: 1.43 (95% CI 1.06–1.92)
Abstract Introduction and objectives Paradoxical low-flow, low-gradient aortic stenosis (PLF-LG AS) with preserved left ventricular ejection fraction (LVEF) is associated with a more complex physiology, worse functional outcomes, higher rates of therapeutic futility, and hospital readmissions after transcatheter aortic valve implantation (TAVI) compared with classical high-gradient aortic stenosis (CAS). However, its impact on mortality remains inconclusive. This study aims to characterize and compare the clinical and echocardiographic profile of patients with PLF-LG AS vs CAS. Additionally, we aim to analyse the incidence of clinical events during follow-up (heart failure hospitalizations and mortality) post-TAVI. Methods Retrospective analysis of a prospective single-centre cohort of patients with severe AS treated with TAVI at a tertiary centre between 2008 and 2023. Out of 1134 patients, those with LVEF 50% were excluded (n=254), and baseline clinical and echocardiographic characteristics as well as the incidence of events between patients with PLF-LG AS (n=131) and CAS (n=749) were compared. Results Mean age of patients analyzed (n=880) was 82.5 (5.6) years, and 504 (57%) were female. No significant differences between groups were found regarding clinical or epidemiological characteristics. PLF-LG AS patients had lower indexed left ventricular volume, worse ventricular function (LVEF and global longitudinal strain), and more impaired left atrial function (lower reservoir strain and higher stiffness index). The prevalence of moderate or severe tricuspid regurgitation was significantly higher in patients with PLF-LG AS, and a non-significant trend towards worse right ventricular-pulmonary artery coupling was also found in this group (Table 1). PLF-LG AS was significantly associated with increased all-cause mortality during follow-up (HR 1.43; 95% CI: 1.06–1.92) (Figure), along with a higher rate of the combined endpoint of cardiovascular mortality and heart failure readmissions (HR 1.52; 95% CI: 1.02–2.30). Conclusions In our cohort, PLF-LG AS was associated with a more unfavourable structural and functional echocardiographic profile compared to CAS, and a significantly higher incidence of adverse clinical outcomes after TAVI. These findings suggest that patients with PLF-LG AS represent a high-risk group that would benefit from a comprehensive assessment and management of the cardiac damage underlying their valvular disease. Table: Clinical and echocardiographic profile of patients with classical high-gradient and paradoxical low-flow, low-gradient aortic stenosis with preserved left ventricular ejection fraction Figure: Kaplan-Meier survival curves for all-cause mortality: paradoxical low-flow, low-gradient vs. classical high-gradient aortic stenosis.Clinical and echocardiographic profile Kaplan-Meier survival curves
Novoa et al. (Thu,) conducted a cohort in Severe aortic stenosis (n=880). Paradoxical low-flow, low-gradient aortic stenosis vs. Classical high-gradient aortic stenosis was evaluated on All-cause mortality (HR 1.43, 95% CI 1.06-1.92). Paradoxical low-flow, low-gradient aortic stenosis was associated with increased all-cause mortality after TAVI compared to classical high-gradient aortic stenosis (HR 1.43; 95% CI 1.06-1.92).