Atrial fibrillation, lower DVI, and lower LVEF independently predicted heart failure hospitalization (p=0.008, p=0.024, p=0.035), but no independent predictors were found for the primary composite.
Observational (n=50)
Yes
In patients with low-flow, low-gradient aortic stenosis, atrial fibrillation, lower Doppler velocity index, and lower LVEF independently predict heart failure hospitalization.
Abstract Introduction Low-flow, low-gradient (LFLG) aortic stenosis (AS) is characterized by discordant findings on resting echocardiography, posing diagnostic challenges. Current evidence suggests that patients with LFLG AS have higher all-cause mortality and heart failure (HF) hospitalizations compared to other AS subtypes. Purpose To identify baseline characteristics that predict clinical outcomes in patients with LFLG AS. Methods Multicenter, retrospective study. We included consecutive patients admitted with LFLG AS between 2021 and 2023 who underwent echocardiography while in sinus rhythm. Patients with missing echocardiographic data were excluded. Data collected included demographics, resting echocardiographic parameters, N-terminal pro B-type natriuretic peptide (NT-proBNP), and aortic valve calcium score (AVCS). The primary outcome was a composite of all-cause mortality and HF hospitalization; secondary outcomes included all-cause mortality and HF hospitalization individually. Results A total of 50 patients were included, with 60% being male. Baseline characteristics are summarized in Table 1. Based on echocardiography data, 66% of patients were classified as classical LFLG and 34% as paradoxical LFLG. Regarding outcomes, 64% met the primary outcome, 46% had HF hospitalization and 48% died. Univariate analysis revealed that hypertension (69% vs. 38%, p=0.030), smoking (82% vs. 59%), AF (83% vs. 57%, p=0.026), classical LFLG (76% vs. 41%, p=0.034), and lower LVEF (39% vs. 48%, p=0.027) were associated with the primary outcome. However, no independent predictors were found. Predictors of HF hospitalization included lower DVI (0.21 vs. 0.23; p=0.039), lower LVEF (38% vs. 46%; p=0.041), history of AF (37% vs. 82%; p=0.010), and classical LFLG AS (62% vs. 20%; p=0.007). Multivariate analysis showed that AF (p=0.008), DVI (p=0.024), and LVEF (p=0.035) were independent predictors of HF hospitalization. There were no significant predictors for all-cause mortality. Conclusion In our cohort of patients with LFLG AS, hypertension, smoking history, AF, classical form of LFLG, and reduced LVEF were associated with the composite outcome of all-cause mortality and HF hospitalization. However, no independent predictors for this combined endpoint were identified. Regarding HF hospitalization, AF, lower DVI and lower LVEF were independently associated with more hospitalization. Although several baseline characteristics were linked to adverse outcomes, no predictors of all-cause mortality were established. These results highlight the importance of comprehensive baseline evaluation for risk stratification and management in this challenging population. Further studies are necessary to validate our findings.Table 1
Viana et al. (Thu,) conducted a observational in Low-flow, low-gradient aortic stenosis (n=50). Baseline clinical and echocardiographic characteristics was evaluated on Composite of all-cause mortality and HF hospitalization. Atrial fibrillation, lower DVI, and lower LVEF independently predicted heart failure hospitalization (p=0.008, p=0.024, p=0.035), but no independent predictors were found for the primary composite.