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).
Cohort (n=110)
Does the timing of aortic valve replacement and the gradient subtype affect prognosis in patients with symptomatic aortic stenosis?
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.
Effect estimate: HR 1.52 (95% CI 1.10-2.11)
p-value: p=0.012
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 0.920.86-0.98), 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.
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).