TY  - BOOK
AU  - Ben-Dor, Itsik
AU  - Goldstein, Steven A
AU  - Hauville, Camille
AU  - Iyasu, Getachew D
AU  - Laynez-Carnicero, Ana
AU  - Lindsay, Joseph
AU  - Maluenda, Gabriel
AU  - Okubagzi, Petros
AU  - Pichard, Augusto D
AU  - Satler, Lowell F
AU  - Torguson, Rebecca
AU  - Waksman, Ron
AU  - Xue, Zhenyi
TI  - Comparison of outcome of higher versus lower transvalvular gradients in patients with severe aortic stenosis and low (<40%) left ventricular ejection fraction
SN  - 0002-9149
PY  - 2012///
KW  - *Aortic Valve Stenosis/di [Diagnosis]
KW  - *Aortic Valve Stenosis/su [Surgery]
KW  - *Aortic Valve/su [Surgery]
KW  - *Cardiac Catheterization
KW  - *Heart Valve Prosthesis Implantation
KW  - *Stroke Volume
KW  - Aged, 80 and over
KW  - Aged
KW  - Algorithms
KW  - Aortic Valve Stenosis/mo [Mortality]
KW  - Aortic Valve Stenosis/pp [Physiopathology]
KW  - Aortic Valve/pp [Physiopathology]
KW  - Cardiac Catheterization/mt [Methods]
KW  - Cohort Studies
KW  - Female
KW  - Follow-Up Studies
KW  - Humans
KW  - Male
KW  - Prospective Studies
KW  - Risk Assessment
KW  - Risk Factors
KW  - Severity of Illness Index
KW  - Survival Analysis
KW  - Treatment Outcome
KW  - MedStar Health Research Institute
KW  - MedStar Heart & Vascular Institute
KW  - Comparative Study
KW  - Journal Article
KW  - Randomized Controlled Trial
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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
UR  - http://dx.doi.org/10.1016/j.amjcard.2011.11.041
ER  -