Key result
Low-gradient aortic stenosis linked to fewer AVRs and significantly worse outcomes versus high-gradient stenosis.
Why the study?
Treatment strategy for low-gradient aortic stenosis remains unresolved, as low gradient with preserved LVEF may lead to underestimating severity and more conservative management.
Does the timing of aortic valve replacement and the gradient subtype affect prognosis in patients with symptomatic aortic stenosis?
Cohort (n=110)
Does the timing of aortic valve replacement and the gradient subtype affect prognosis in patients with symptomatic aortic stenosis?
Answers are grounded in this paper and cite their sources.
Patients with low-gradient aortic stenosis are less likely to undergo aortic valve replacement and have worse outcomes compared to those with high-gradient aortic stenosis.
BACKGROUND: Treatment strategy for low-gradient (LG) aortic stenosis (AS) remains an unresolved issue. The presence of a low aortic gradient and preserved left ventricular ejection fraction (LVEF) might lead toward the underestimation of aortic stenosis severity and a more conservative management. We sought (a) to describe the nature and timing of intervention according to flow/gradient subgroups in patibents with LG-AS, (2) to determine the factors associated with the decision to intervene, and (c) to describe prognosis. METHODS AND RESULTS: One hundred and ten patients prospectively included in this study underwent a standardized clinical and imaging evaluation at inclusion and at 1-year follow-up. According to aortic flow, gradient and LVEF, patients were divided into 4 groups: LG-normal flow [n = 27], LG-low flow-low LVEF [n = 27], LG-low flow-normal LVEF [n = 16], and high gradient (HG) [n = 40]). 73% of patients underwent AVR 86 ± 59 days after the initial assessment. The HG subgroup had significantly higher intervention rates (P < .001). In multivariable analysis, four parameters were associated with the AVR: aortic gradient (HR 1.52 [1.10-2.11], P = .012), LVEF (HR 0.58 [0.40-0.85], P = .006), atrial fibrillation (HR 0.43 [0.021-0.87], P = .019), and NT-proBNP (HR 0.92[0.86-0.98), P = .008]. Patients operated earlier had better outcomes than those having a delayed AVR (P = .042). LG-AS patients had worse outcomes than HG-AS patients (P < .001). CONCLUSION: Compared to HG-AS, LG-AS is less likely to benefit from an AVR and had a significantly worse outcome. Further interventional studies are needed to investigate the timing of AVR in these patients.
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Bridonneau et al. (2019) conducted a cohort in Symptomatic aortic valve stenosis (n=110). Aortic valve replacement (AVR) vs. Conservative management / High-gradient AS was evaluated on Aortic valve replacement (HR 1.52, 95% CI 1.10-2.11, p=0.012). Patients with low-gradient aortic stenosis were less likely to undergo aortic valve replacement than those with high-gradient stenosis and had significantly worse outcomes (P<0.001).
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