Predictors of Mortality and Outcomes of Therapy in Low-Flow Severe Aortic Stenosis: A Placement of Aortic Transcatheter Valves (PARTNER) Trial Analysis

被引：326

作者：

Herrmann, Howard C. ^{[1
]}

Pibarot, Philippe ^{[2
]}

Hueter, Irene ^{[3
,4
]}

Gertz, Zachary M. ^{[5
]}

Stewart, William J. ^{[6
]}

Kapadia, Samir ^{[6
]}

Tuzcu, E. Murat ^{[6
]}

Babaliaros, Vasilis ^{[7
]}

Thourani, Vinod ^{[7
]}

Szeto, Wilson Y. ^{[1
]}

Bavaria, Joseph E. ^{[1
]}

Kodali, Susheel ^{[3
,4
]}

Hahn, Rebecca T. ^{[3
,4
]}

Williams, Mathew ^{[3
,4
]}

Miller, D. Craig ^{[8
]}

Douglas, Pamela S. ^{[9
]}

Leon, Martin B. ^{[3
,4
]}

机构：

[1] Univ Penn, Philadelphia, PA 19104 USA

[2] Univ Laval, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[3] Cardiovasc Res Fdn, New York, NY USA

[4] Columbia Univ, New York, NY USA

[5] VCU Sch Med, Richmond, VA USA

[6] Cleveland Clin, Cleveland, OH 44106 USA

[7] Emory Univ, Atlanta, GA 30322 USA

[8] Stanford Univ, Palo Alto, CA 94304 USA

[9] Duke Univ, Durham, NC USA

来源：

CIRCULATION | 2013年 / 127卷 / 23期

关键词：

aortic valve stenosis; blood flow velocity; heart valves; OPERATIVE RISK STRATIFICATION; PROSTHESIS-PATIENT MISMATCH; OUTFLOW TRACT ECCENTRICITY; EJECTION FRACTION; AMERICAN-SOCIETY; GORLIN FORMULA; GRADIENT; REPLACEMENT; ECHOCARDIOGRAPHY; MULTICENTER;

D O I：

10.1161/CIRCULATIONAHA.112.001290

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background- The prognosis and treatment of patients with low-flow (LF) severe aortic stenosis are controversial. Methods and Results- The Placement of Aortic Transcatheter Valves (PARTNER) trial randomized patients with severe aortic stenosis to medical management versus transcatheter aortic valve replacement (TAVR; inoperable cohort) and surgical aortic valve replacement versus TAVR (high-risk cohort). Among 971 patients with evaluable echocardiograms (92%), LF (stroke volume index <= 35 mL/m(2)) was observed in 530 (55%); LF and low ejection fraction (<50%) in 225 (23%); and LF, low ejection fraction, and low mean gradient (<40 mm Hg) in 147 (15%). Two-year mortality was significantly higher in patients with LF compared with those with normal stroke volume index (47% versus 34%; hazard ratio, 1.5; 95% confidence interval, 1.25-1.89; P=0.006). In the inoperable cohort, patients with LF had higher mortality than those with normal flow, but both groups improved with TAVR (46% versus 76% with LF and 38% versus 53% with normal flow; P<0.001). In the high-risk cohort, there was no difference between TAVR and surgical aortic valve replacement. In patients with paradoxical LF and low gradient (preserved ejection fraction), TAVR reduced 1-year mortality from 66% to 35% (hazard ratio, 0.38; P=0.02). LF was an independent predictor of mortality in all patient cohorts (hazard ratio, approximate to 1.5), whereas ejection fraction and gradient were not. Conclusions- LF is common in severe aortic stenosis and independently predicts mortality. Survival is improved with TAVR compared with medical management and similar with TAVR and surgical aortic valve replacement. A measure of flow (stroke volume index) should be included in the evaluation and therapeutic decision making of patients with severe aortic stenosis. Clinical Trial Registration- URL: http://www.clinicaltrial.gov. Unique identifier: NCT0053089.4.

引用

页码：2316 / 2326

页数：11

共 30 条

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