Key result
Classic low-flow, low-gradient severe aortic stenosis was independently associated with a significantly higher risk of major adverse cardiac and cerebrovascular events (HR 5.53) after surgical aortic valve replacement.
Why the study?
It was unclear whether cardiac CT findings can predict and have prognostic implications in low-flow, low-gradient aortic stenosis, which derives less benefit from surgery among aortic stenosis subtypes.
Do cardiac CT findings and AS subtypes predict major adverse cardiac and cerebrovascular events in patients with severe AS undergoing surgical AVR?
Observational (n=511)
Do cardiac CT findings and AS subtypes predict major adverse cardiac and cerebrovascular events in patients with severe AS undergoing surgical AVR?
Effect estimate: HR 5.53 (95% CI 1.74-17.56)
Absolute Event Rate: 27.8% vs 7.8%
p-value: p=0.004
In patients with severe aortic stenosis undergoing surgical AVR, classic low-flow, low-gradient AS and a smaller CT-derived aortic annulus area are strong independent predictors of postoperative major adverse cardiac and cerebrovascular events.
Aortic valve calcium scoring by cardiac computed tomographic (CT) has been recommended as an alternative to classify the AS severity, but it is unclear that whether CT findings can predict and have prognostic implication in low-flow, low-gradient aortic stenosis (LF-LG AS), which has fewer benefit from surgery among the AS subtypes. In this study, we examined the clinical and cardiac CT findings of LF-LG AS patients and evaluated factors affecting outcomes after surgical aortic valve replacement (AVR). This study included 511 (66.9±8.8 years, 55% men) consecutive patients with severe AS who underwent surgical AVR. Aortic valve area (AVA) was obtained by echocardiography (AVA echo ) and by CT (AVA CT ) using each modalities measurement of the left ventricular outflow tract. Patients with AS were classified as 1) high-gradient severe (n=438), 2) classic LF-LG (n=18), and 3) paradoxical LF-LG (n=55) based on echocardiography. Classic LF-LG AS patients had higher end-systolic and end-diastolic volume indices, lower left ventricular ejection fraction, larger AVA echo and AVA CT , and larger aortic annulus compared to high-gradient severe AS (P<0.05, for all). In classic LF-LG AS group, 27.8% of patients presented AVA CT ≥1.2 cm 2 . After multivariable adjustment, old age (hazard ratio [HR], 1.04, P=0.049), high B-type natriuretic peptide (BNP) (HR, 1.005; P<0.001), preoperative atrial fibrillation (HR, 2.75; P=0.003), classic LF-LG AS (HR, 5.53, P=0.004), and small aortic annulus (HR, 0.57; P=0.002) were independently associated with major adverse cardiac and cerebrovascular events (MACCE). The classic LF-LG AS group presented larger AVA CT and aortic annulus than those in high-gradient severe AS group and one third of them had AVA CT ≥1.2 cm 2 . Old age, high BNP, atrial fibrillation, classic LF-LG AS, and small aortic annulus were associated with MACCE in severe AS patients after surgical AVR.
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Choi et al. (2021) conducted an observational in Severe Aortic Stenosis (n=511). Classic low-flow, low-gradient severe aortic stenosis vs. High-gradient severe aortic stenosis was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) (HR 5.53, 95% CI 1.74-17.56, p=0.004). Classic low-flow, low-gradient severe aortic stenosis was independently associated with a significantly higher risk of major adverse cardiac and cerebrovascular events (HR 5.53) after surgical aortic valve replacement.
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