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Comparison of outcome of higher versus lower transvalvular gradients in patients with severe aortic stenosis and low (<40%) left ventricular ejection fraction.

by Ben-Dor, Itsik; Maluenda, Gabriel; Iyasu, Getachew D; Laynez-Carnicero, Ana; Hauville, Camille; Torguson, Rebecca; Okubagzi, Petros; Xue, Zhenyi; Goldstein, Steven A; Lindsay, Joseph; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron.
Citation: American Journal of Cardiology. 109(7):1031-7, 2012 Apr 1..Journal: The American journal of cardiology.ISSN: 0002-9149.Full author list: Ben-Dor I; Maluenda G; Iyasu GD; Laynez-Carnicero A; Hauville C; Torguson R; Okubagzi P; Xue Z; Goldstein SA; Lindsay J; Satler LF; Pichard AD; Waksman R.UI/PMID: 22257710.Subject(s): Aged | Aged, 80 and over | Algorithms | Aortic Valve/pp [Physiopathology] | *Aortic Valve/su [Surgery] | *Aortic Valve Stenosis/di [Diagnosis] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/pp [Physiopathology] | *Aortic Valve Stenosis/su [Surgery] | Cardiac Catheterization/mt [Methods] | *Cardiac Catheterization | Cohort Studies | Female | Follow-Up Studies | *Heart Valve Prosthesis Implantation | Humans | Male | Prospective Studies | Risk Assessment | Risk Factors | Severity of Illness Index | *Stroke Volume | Survival Analysis | Treatment OutcomeInstitution(s): MedStar Heart & Vascular Institute | MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Comparative Study | Journal Article | Randomized Controlled TrialOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1016/j.amjcard.2011.11.041 (Click here) Abbreviated citation: Am J Cardiol. 109(7):1031-7, 2012 Apr 1.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: Left ventricular systolic dysfunction in patients with severe aortic stenosis (AS) is associated with poor outcome. This analysis was designed primarily to describe the clinical course of a large series of consecutive patients with severe AS and low ejection fraction (EF) (<40%) who, because of high surgical risk, were referred for transcatheter aortic valve implantation consideration. A cohort of 270 patients with severe AS and low EF (<40%) who were referred to participate in a clinical trial of transcatheter aortic valve implantation was studied. Clinical, hemodynamic, and periprocedural complications and follow-up mortality data were collected and compared between patients with low mean transvalvular gradients (<=40 mm Hg, n = 170 [63%]) and high transvalvular gradients (>40 mm Hg, n = 100 [37%]). Patients with low gradients were younger (mean age 79.8 +/- 9.1 vs 83.8 +/- 7.7 years, p <0.001) and had higher incidences of coronary artery disease and renal failure. Mean aortic valve area was larger (0.73 +/- 0.23 vs 0.53 +/- 0.18 cm(2), p <0.001), while mean EF (26.4 +/- 6.9% vs 30.5% +/- 6.6%, p <0.001), cardiac output (3.7 +/- 1.1 vs 4.1 +/- 1.3 L/min, p = 0.04), and cardiac index (1.9 +/- 0.5 vs 2.1 +/- 0.6 L/min/m(2), p = 0.04) were lower in patients with lower gradients compared to those with higher gradients, respectively. Mortality was higher in patients with low gradients (53.8%) at a mean follow-up of 151 days compared to those with high gradients (41%) at a mean follow-up of 256 days (p = 0.01). In conclusion, patients with severe AS and low EF with low transvalvular gradients are at higher risk for worse outcomes compared to patients with high transvalvular gradients. Surgery or transcatheter aortic valve implantation treatment and high baseline transvalvular gradient are associated with EF improvement. Copyright A 2012. Published by Elsevier Inc.

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