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

MedStar author(s):
Citation: American Journal of Cardiology. 109(7):1031-7, 2012 Apr 1.PMID: 22257710Institution: MedStar Health Research Institute | MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Randomized Controlled TrialSubject headings: *Aortic Valve Stenosis/di [Diagnosis] | *Aortic Valve Stenosis/su [Surgery] | *Aortic Valve/su [Surgery] | *Cardiac Catheterization | *Heart Valve Prosthesis Implantation | *Stroke Volume | Aged, 80 and over | Aged | Algorithms | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve/pp [Physiopathology] | Cardiac Catheterization/mt [Methods] | Cohort Studies | Female | Follow-Up Studies | Humans | Male | Prospective Studies | Risk Assessment | Risk Factors | Severity of Illness Index | Survival Analysis | Treatment OutcomeYear: 2012Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: 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.All authors: Ben-Dor I, Goldstein SA, Hauville C, Iyasu GD, Laynez-Carnicero A, Lindsay J, Maluenda G, Okubagzi P, Pichard AD, Satler LF, Torguson R, Waksman R, Xue ZFiscal year: FY2012Digital Object Identifier: Date added to catalog: 2013-09-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 22257710 Available 22257710

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

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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