Differential left ventricular remodelling and longitudinal function distinguishes low flow from normal-flow preserved ejection fraction low-gradient severe aortic stenosis

被引:136
作者
Mehrotra, Praveen [1 ,2 ]
Jansen, Katrijn [1 ,2 ]
Flynn, Aidan W. [1 ,2 ]
Tan, Timothy C. [1 ,2 ]
Elmariah, Sammy [2 ,3 ]
Picard, Michael H. [1 ,2 ]
Hung, Judy [1 ,2 ]
机构
[1] Massachusetts Gen Hosp, Div Cardiol, Cardiac Ultrasound Lab, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Boston, MA 02114 USA
[3] Massachusetts Gen Hosp, Div Cardiol, Cardiac Catheterizat Lab, Boston, MA 02114 USA
基金
美国国家卫生研究院;
关键词
Aortic stenosis; Echocardiography; Remodelling; Haemodynamics; PARADOXICAL LOW-FLOW; VALVE STENOSIS; MYOCARDIAL FIBROSIS; ECHOCARDIOGRAPHIC-ASSESSMENT; SYSTOLIC FUNCTION; SPECKLE-TRACKING; RECOMMENDATIONS; QUANTIFICATION; GUIDELINES; AFTERLOAD;
D O I
10.1093/eurheartj/eht094
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
There is uncertainty in identifying patients with severe aortic stenosis (AS) with preserved left ventricular (LV) ejection fraction, low flow, and low gradients (LFLG). Prior studies propose that these patients demonstrate significant concentric remodelling and decreased survival, while others suggest that they have features and survival similar to moderate AS. We compared the clinical characteristics, echocardiographic features, and overall survival of LFLG AS patients (n 38) to those with normal-flow, low-gradient (NFLG) severe AS (n 75) and moderate AS (n 70). Low-flow, low-gradient patients had the lowest end-diastolic volume index (43 vs. 54 vs. 54 mL/m(2), P 0.001), highest relative wall thickness (RWT) (60 vs. 49 vs. 48, P 0.001), and lowest septal mitral annular displacement (1.0 vs. 1.5 vs. 1.5 cm, P 0.001). New York Heart Association (NYHA) class III/IV symptoms were the most frequent in the LFLG group (29 vs. 11 vs. 3, P 0.001). Survival at 3 years was significantly lower in LFLG compared with NFLG (P 0.006) and moderate AS (P 0.002), but not different between NFLG and moderate AS (P 0.49). Higher NYHA classification (HR 1.77, 95 CI 1.222.57), RWT 50 (HR 3.28, 95 CI 1.338.1), and septal displacement 1.1 cm (HR 3.93, 95 CI 1.967.82) but not low flow were independent predictors of survival in Cox proportional hazards analysis. Preserved ejection fraction, LFLG AS patients exhibit marked concentric remodelling and impaired longitudinal functionalufeatures that predict their poor long-term survival. Normal-flow, low-gradient AS patients have outcomes similar to moderate AS.
引用
收藏
页码:1906 / 1914
页数:9
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