Key result
Low-flow, low-gradient AS with preserved EF is linked to ~60% lower valve calcification versus reduced EF.
Why the study?
How do aortic valve calcification and valvuloarterial impedance differ among patients with severe aortic stenosis classified by flow and gradient patterns?
Observational (n=181)
How do aortic valve calcification and valvuloarterial impedance differ among patients with severe aortic stenosis classified by flow and gradient patterns?
p-value: p=< .0001
Low-gradient/low-flow aortic stenosis with preserved ejection fraction is associated with lower aortic valve calcification, suggesting it may represent less severe AS with an adaptive ventricular response.
May indicate milder disease in low-gradient low-flow preserved-EF AS; leaves open phenotype-specific calcification thresholds.
Different patterns of flow and valve gradients can lead to diagnostic uncertainty about the severity of aortic stenosis (AS). Consecutive patients with severe AS (valve area <1 cm 2 ) underwent echocardiography and computed tomography. Patients were classified into 4 groups (high-gradient/normal flow [HG NF ], high-gradient/low flow [HG LF ], low-gradient/normal flow [LG NF ], and low-gradient/low flow [LG LF ]). Low flow was defined as stroke volume index <35 mL/m 2 and low gradient as a mean aortic gradient <40 mm Hg. Aortic valve calcification (AVC) was calculated using the Agatston score. Of 181 patients, 56, 30, 46, and 49 had HG NF , HG LF , LG NF and LG LF with median AVC of 2048, 2015, 1366, and 1178 AU/m 2 ( P < .0001) and valvuloarterial impedance of 4.5, 6.4, 4.2, and 5.9, respectively ( P < .0001). Among those with LG LF , AVC was lower in patients with preserved compared to reduced left ventricular ejection fraction (1018 vs 2550 AU/m 2 ; P < .0001), but valvuloarterial impedance was similar ( P = .33). The LG LF AS with preserved ejection fraction is associated with lower AVC and may identify patients with less severe AS in association with an adaptive ventricular response to high afterload.
No takes yet. Share an insight, caveat, or question.
Bhattacharyya et al. (2015) conducted an observational in severe aortic stenosis (n=181). Classification by flow and gradient patterns was evaluated on Aortic valve calcification (AVC) and valvuloarterial impedance (p=< .0001). Low-gradient/low-flow aortic stenosis with preserved ejection fraction is associated with lower aortic valve calcification compared to reduced ejection fraction (1018 vs 2550 AU/m2; P<.0001).